The relaxed perineum and anorectal disease

Functional and physiological outcome following transanal repair of rectocele

“…Bartram et al 22 , in a proctographic study, found that up to 80 per cent of asymptomatic women had rectoceles, supporting the findings of Block 2 who had reported that less that a quarter of women with a clinical rectocele were symptomatic. Neglect of a rectocele has previously been shown to result in failure of other anorectal surgery 15 , but identifying a rectocele as the primary cause of a patient's symptoms is more unlikely as the cause of symptoms is often multifactorial. Transanal rectocele repair has been referred to as an anterior internal Delorme procedure, as the anterior mucosal intussusception and prolapse are reduced in addition to correction of the rectocele.…”

“…Mellgren et al 14 reported that almost 50 per cent of patients continued to have some degree of constipation following posterior colporrhaphy. Redding 15 reported that neglect of the rectocele resulted in failure of other anorectal surgery and in 1967 Marks 16 identified the presence of 'the loose inner lining of the rectocele in the rectal ampulla' following transvaginal repair. Transanal repair has been considered to address the anorectal component of rectoceles in contrast to the transvaginal approach.…”

The impact of anismus on the clinical outcome of rectocele repair

“…Since the publication of Redding in 1965, it has become obvious that a rectocele can give rise not only to gynaecological symptoms, but also to obstructed defecation [21]. Most often the evacuation difficulties arise during the fourth or fifth decade of life, when progressive weakening of the supportive tissues occurs [22].…”

Transanal rectocele repair using EndoGIA: short–term results of a prospective study

“…It may be related to a deficient perineum. Pelvic floor innervations and musculature damage caused by vaginal delivery and excessive frequent straining during constipation, post-menopause estrogenic deficiency and paradoxical contraction of puborectalis muscle seem to be the most important etiologic factors [2]. Recently, a difference in the rectovaginal pressure gradient caused by diminished puborectalis and bulbocavernosus muscles contractile activity on coughing or straining, with significant increase in the rectal against the vaginal pressure, has been suggested to be the main pathogenesis of rectocele [3].…”