Rectocele/Obstructed Defecation · Conservative vs Repair

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Symptoms + defecography + concomitant prolapse
   Symptom severity? Defecography? Concomitant intussusception/other prolapse?
   • Mild symptoms/not adequately treated conservatively → Mild symptoms → conservative
   • Symptomatic rectocele (vaginal bulge, needs digital assistance), confirmed on defecography → Symptomatic bulge → transvaginal/transanal repair
   • Predominant rectal intussusception/obstructed defecation → Intussusception-predominant → STARR
   • Concomitant apical/anterior compartment prolapse → Concomitant prolapse → joint pelvic floor reconstruction
2. [End] Mild symptoms → conservative
   First-line conservative: dietary fiber/laxatives, pelvic floor muscle training/biofeedback, bowel habit adjustment, manual support; most improve.
3. [End] Symptomatic bulge → transvaginal/transanal repair
   Symptomatic rectocele, conservative failure, confirmed on defecography (barium trapping, needs digital assistance) → repair: transvaginal posterior wall repair (gynecologic approach) or transperineal/transanal repair.
4. [End] Intussusception-predominant → STARR
   Predominant rectal intussusception/obstructed defecation → stapled transanal rectal resection (STARR) etc.; strict selection, watch for complications (pain/urgency).
5. [End] Concomitant prolapse → joint pelvic floor reconstruction
   Concomitant apical/anterior compartment prolapse → joint pelvic floor reconstruction (e.g. sacrocolpopexy + posterior repair); urogynecology and colorectal multidisciplinary.

Source guidelines & references

• Rectocele and obstructed defecation (ASCRS; defecography assessment)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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