Outcomes of Rectoceles Identified During the Investigation of Obstructive Defaecation Syndrome

Rectocele is a frequent cause of obstructed defecation and pelvic floor symptoms, yet Local data on presentation patterns and care pathways are limited. This study was aimed to evaluate patient characteristics, diagnosis spectrum and correlate symptoms with diagnosis and management in our hospital. It is a Retrospective observational study at Colchester General Hospital, ESNEFT. The study duration is 5 years, from January 2019 to December 2023. All patients who attended the Surgical outpatient clinic with features of obstructive defaecation symptoms and had a confirmed imaging diagnosis of rectocele in proctogram were included in this study. Among 132 patients with obstructive defecation syndrome (ODS), the majority were female 130(98.0%), with a mean age of 57.0±14.7 years, predominantly aged 50-64 years. Nearly half 62(47.0%), were diagnosed with rectocele combined with intussusception, 37(28.0%) with isolated rectocele and 33(25.0%) with rectocele with other pelvic floor disorders. The most frequent presenting symptoms were faecal incontinence 57(43.2%) and chronic constipation 55(41.7%) with others including incomplete evacuation, vaginal lump, rectal lump, passive faecal leakage during defaecation and prolapse. Chronic constipation and faecal incontinence remain the common symptoms at presentation in patients with rectocele. Conservative management, chiefly physiotherapy, was initiated in 121(91.7%) of patients, while surgical intervention was 5(3.78%). Most patients 118(89.4%) did not require further follow-up and 4(3.0%) showed excellent symptom improvement. Faecal incontinence and constipation dominate the symptom profile in our cohort. Most Patients had rectocele coexist with other pelvic floor pathologies, highlighting the need for Multidisciplinary assessment and conservative management remains the mainstay of treatment.