PURPOSE: This study was designed to evaluate the results of rectocele
repair and parameters that might be useful in selecting patients for t
his operation. METHODS: Twenty-five patients with symptom-giving recto
celes were prospectively evaluated with a standardized questionnaire,
physical examination, defecography, colon transit studies, anorectal m
anometry, and electrophysiology. Patients underwent posterior colporrh
aphy and perineorrhaphy. They were followed postoperatively (mean, 1.0
year) with the same questionnaire, physical examination, defecography
, anorectal manometry, and electrophysiology. RESULTS: Constipation ha
d improved postoperatively in 21 of 24 constipated patients (88 percen
t). At postoperative follow-up 13 patients (52 percent) had no constip
ation symptoms, 8 (32 percent) had occasional symptoms, and 4 (16 perc
ent) had symptoms more than once per week. Four patients with rectocel
e at preoperative defecography, but not at physical examination, had f
avorable outcomes following surgery. The majority of patients not usin
g vaginal digitalization preoperatively had improved with respect to c
onstipation. AU patients with pathologic transit studies had various d
egrees of constipation postoperatively. Constipation was not improved
in two of five patients with preoperative paradoxic sphincter reaction
. CONCLUSIONS: Rectocele is one cause of constipation that can be trea
ted with good results. Preoperative use of vaginal digitalization is n
ot mandatory for a good postoperative result. Defecography is an impor
tant complement to physical examination. Patients with pathologic tran
sit study might have a less favorable outcome of rectocele repair with
respect to constipation. More studies about the significance of parad
oxic sphincter reaction in these patients are indicated.