What are the treatment options for symptoms from a rectocele?

From the Guidelines

Surgical interventions, such as STARR, may be considered for symptomatic rectoceles, but the correlation between symptoms and rectocele size is weak, and the long-term outcomes are somewhat disappointing. Treatment options for symptoms from a rectocele include conservative approaches, such as dietary modifications, stool softeners, and pelvic floor muscle exercises, as well as surgical interventions like STARR or biofeedback therapy 1.

Key Considerations

• The choice of treatment depends on symptom severity, the patient's overall health, and personal preferences.
• Conservative management is typically recommended first, including dietary modifications to prevent constipation and pelvic floor muscle exercises.
• For severe symptoms that significantly impact quality of life and don't respond to conservative measures, surgical repair may be necessary.
• The STARR procedure has been shown to improve symptoms in some patients, but it is also associated with adverse events, such as infection, pain, incontinence, bleeding, UTI, or depression 1.

Treatment Options

• Conservative management:
  • Dietary modifications (increased fiber intake and adequate hydration)
  • Stool softeners (like docusate sodium)
  • Pelvic floor muscle exercises (Kegel exercises)
• Surgical interventions:
  • STARR procedure
  • Biofeedback therapy
  • Posterior colporrhaphy (for severe symptoms that significantly impact quality of life)

Important Considerations

• The correlation between symptoms and rectocele size is weak, and the correlation between improvement in symptoms and anatomy after the STARR procedure is also weak 1.
• Anatomic abnormalities, such as intussusception and complete rectal prolapse, may be caused by the underlying disorder of function (impaired pelvic floor relaxation and excessive straining), which is not corrected by the procedure 1.

From the Research

Symptoms of Rectocele

• Dyschezia, requiring digital disimpaction maneuvers 2
• Pelvic heaviness 2
• Anal incontinence 2
• Dyspareunia 2
• Obstructive defecation syndrome (ODS) 3
• Feeling of vaginal prolapse/bulge 3
• Impaired rectal evacuation 4

Treatment Options for Symptoms of Rectocele

• Conservative measures:
  • Pelvic floor physiotherapy 5
  • Behavioral therapy 5, 4
  • Biofeedback therapy 4
  • Pessaries 5
• Surgical management:
  • Transvaginal rectocele repair (TVRR) 3
  • Traditional posterior colporrhaphy 5
  • Transabdominal rectopexy 2, 6
  • Native tissue transvaginal rectocele repair (TVRR) combined with levatorplasty 3

Considerations for Treatment

• The choice of treatment depends on the severity of symptoms and the presence of other pelvic disorders 2
• Surgical management should be considered after failure of conservative measures 2, 6
• The type of rectocele (low, mid, or high) and the presence of other disorders of pelvic stasis should be taken into account when choosing a surgical approach 2