Are rectoceles the cause or the result of obstructed defaecation syndrome? A prospective anorectal physiology study

C. W. Hicks, M. Weinstein, M. Wakamatsu, S. Pulliam, L. Savitt, L. Bordeianou

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Aim: To determine the relationship between obstructed defaecation syndrome (ODS) and rectoceles. Method: From December 2007 to November 2011, all female patients with ODS were prospectively evaluated with full interview, clinical examination and anorectal physiology testing. The characteristics of patients with and without rectoceles were compared, and logistic regression was utilized to identify factors predictive of patients having a rectocele beyond the introitus. Results: Of 239 patients with ODS, 90 (mean age: 52.3 ± 1.7 years) had a rectocele. Patients with rectoceles (R+) had a similar prevalence of incomplete emptying compared with patients with no rectocele (R-) (P ≥ 0.21), but only R+ patients reported splinting with defaecation (36.7% vs 0%; P < 0.0001). Anorectal manometry measurements, including mean resting pressure, maximum resting pressure and maximum squeeze pressure, were similar between groups (P ≥ 0.12). There were also no significant differences in rectal compliance (maximum tolerated volume) or rectal sensitivity (volume of first sensation) (P ≥ 0.65). R+ patients had greater difficulty expelling a 60 cm3 balloon (70.1% R+ patients vs 57.5% R- patients; P = 0.05), but the prevalence of pelvic floor dyssynergia, as quantified by nonrelaxation on electromyography (EMG) testing, was similar to that of R- patients (P = 0.49). Logistic regression suggested that only difficulty with balloon expulsion was associated with higher odds of having a rectocele (OR = 3.00; P = 0.002), whereas mean resting pressure, EMG nonrelaxation and symptoms of incomplete emptying were not (P ≥ 0.12). Conclusion: Rectoceles are not associated with an increased severity of ODS-type symptoms, anorectal abnormalities or pelvic floor dyssynergia in patients with ODS. This suggests that rectoceles may be the result, rather than the cause, of ODS.

Original languageEnglish (US)
Pages (from-to)993-999
Number of pages7
JournalColorectal Disease
Issue number8
StatePublished - Aug 2013


  • Anorectal physiology
  • Obstructed defaecation syndrome
  • Rectocele

ASJC Scopus subject areas

  • Gastroenterology


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