[Rectocele : Symptoms, diagnostics and therapy concepts from a coloproctological viewpoint]

Area of Science:

• Gastroenterology and Colorectal Surgery
• Pelvic Floor Disorders
• Functional Bowel Diseases

Background:

• Anterior rectocele is a frequent morphological finding in patients experiencing obstructive defecation syndrome (ODS).
• Symptoms such as incomplete evacuation, digital maneuvers, and soiling are common, often misdiagnosed as fecal incontinence.
• The etiological relationship between rectocele and ODS remains debated.

Purpose of the Study:

• To review the clinical presentation, diagnostic methods, and treatment options for anterior rectocele.
• To discuss the current controversies surrounding rectocele as a cause or consequence of ODS.
• To provide insights into the cautious approach needed for surgical interventions.

Main Methods:

• Clinical diagnosis of rectocele.
• Functional assessment using dynamic imaging techniques, such as magnetic resonance (MR) defecography.
• Review of available conservative and surgical treatment modalities (transanal, transperineal, transvaginal, transabdominal).

Main Results:

• Anterior rectocele is a common finding in ODS patients with specific symptoms.
• Diagnosis relies on clinical evaluation and functional imaging.
• Conservative management is the primary treatment approach.

Conclusions:

• Evidence-based guidelines for surgical rectocele correction are currently lacking.
• The role of rectocele in ODS (cause vs. consequence) is controversial.
• Surgical intervention for rectocele should be approached with caution, considering the unresolved etiological questions.