**1. Introduction**

Rectocele is defined as a herniation of the anterior rectal wall through the posterior vagina wall into its lumen, caused by weakness of the rectovaginal septum. It is more common in postmenopausal women, and pelvic organ prolapse can occur in more than 50% of parous women [1–4]. Usually secondary to multiple vaginal deliveries that may cause pelvic floor injuries, or damages in muscles such as the levator ani or at the rectovaginal septum, even or the pudendal nerve.

In many cases, more than 90%, it is asymptomatic [1]. The symptoms caused by the rectocele may be related to defecatory disorders, constipation, vaginal mass or bulge and pelvic discomfort, and even in some occasions mild fecal incontinence with

#### **Figure 1.**

*Physical examination of rectocele. The superior part of the picture shows the anterior part of the patient, and the inferior part of the picture shows the posterior part of the patient (anal area).*

soiling symptoms. It should be considered as a cause of the well-known Obstructed Defecation Syndrome (ODS) [4]. Thus, in a large percentage of women with rectocele, from 30 to 70% [5], they present symptoms such as difficulty in rectal emptying, excessive straining to defecation, or the need for vaginal digitation to complete defecation.

Despite this relationship, it should be remembered that ODS is a multifactorial entity, and many etiologies have already been related to it. For example, pelvic floor dyssynergia, rectal prolapse, intussusception, and pelvic floor prolapse are some of


#### **Table 1.**

*Classification scheme of surgical techniques for rectocele repair.*
