Diagnosis and therapy in rectoceles [Diagnostik und therapie der rektozele]

Rectoceles are diagnosed more often after vaginal delivery and instrumental delivery as compared to nulliparous women or following caesarean section. Pelvic organ prolapse should be documented according to the rules of the International Continence Society (ICS). Typical symptoms include vaginal mass, constipation and stooling difficulties (outlet obstruction) and splinting. Most likely, the development of a rectocele is due to weakening and tears of the rectovaginal septum. Causes include the same neurogenic and mechanical reasons as discussed for other disturbances of the pelvic floor. Rectocele repair is indicated when the entity is symptomatic. Posterior colporrhaphia is a well established and standardised procedure however in America fascial defect repair is widely used. Colorectal surgeons rather propagate transanal operative techniques, that include gathering and/or excision of rectal mucosa.