Fecal continence after rectocele repair: a prospective study

Combined transvaginal/transanal rectocele repair was performed in series of 89 consecutive women (mean age 55, range 35-81 years) with obstructed defe cation due to a rectocele with a depth of more than 3 cm. The impact of thi s procedure on anal sphincter pressure and continence status was evaluated prospectively. Anorectal manometry was carried out before and after surgery (at 3, 6, 12, and 24 months). The following measurements were performed: m aximal anal resting pressure (MARP), maximal anal squeeze pressure (MASP), and rectal sensory perception including first initial sensation, urge to de fecate, and maximum tolerable volumes (MTV). The outcome was successful in 71% of patients with respect to symptoms such as the need for straining at defecation, manual assistance, feelings of incomplete evacuation, sense of rectal fullness, constipation, abdominal pain, and the use of laxatives. Ho wever, after rectocele repair seven patients experienced deterioration in f ecal continence, and dyspareunia developed in 41% of the sexually active pa tients. Manometric studies revealed a significant decline in mean of 18% of MARP and 16% of MASP. In contrast to MASP, MARP gradually improved during the follow-up period. Distending volumes required for initial sensation and urge to defecate did not change after the procedure. MTV values were signi ficantly lower 3 and 6 months after rectocele repair than those before and 24 months after surgery, MARP and MASP values after surgery did not differ between patients with impaired and those with normal continence. In conclus ion, transvaginal/transanal rectocele repair is beneficial for patients wit h obstructed defecation; however, care should be taken in sexually active p atients, and patients at risk of developing fecal incontinence.