title: In patients with rectoceles and obstructed defecation syndrome, surgery should be the option of last resort.
abstract: BACKGROUND
  The indications for operation in patients with obstructed defecation syndrome (ODS) with rectocele are not well defined.
  
  
  METHODS
  A total of 90 female patients with ODS and rectocele were prospectively evaluated and treated with fiber supplements and biofeedback training. Univariate and multivariate regression was used to determine factors predictive of failing medical management.
  
  
  RESULTS
  Obstructive symptoms were the most prevalent presenting complaint (82.2%). Ultimately, 71.1% of patients responded to medical management and biofeedback. Multivariate regression analysis suggested that the presence of internal intussusception was associated with a lower chance of undergoing surgery to address ODS symptoms [odds ratio 0.18; P = .05], whereas inability to expel balloon, contrast retention on defecography, and splinting were not (P ≥ .15).
  
  
  CONCLUSIONS
  Rectoceles with concomitant intussusception in patients with ODS appear to portend a favorable response to biofeedback and medical management. We argue that all patients considered for surgery for rectoceles because of ODS should first undergo appropriate bowel retraining.
authors: Department of Surgery, Pelvic Floor Disorders Service, Massachusetts General Hospital, Boston, MA; Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD.
authors: Caitlin W
authors: CW
authors: Hicks
authors: Department of Gynecology, Pelvic Floor Disorders Service, Massachusetts General Hospital, Boston, MA.
authors: Milena
authors: M
authors: Weinstein
authors: Department of Gynecology, Pelvic Floor Disorders Service, Massachusetts General Hospital, Boston, MA.
authors: May
authors: M
authors: Wakamatsu
authors: Department of Surgery, Pelvic Floor Disorders Service, Massachusetts General Hospital, Boston, MA.
authors: Lieba
authors: L
authors: Savitt
authors: Department of Gynecology, Pelvic Floor Disorders Service, Massachusetts General Hospital, Boston, MA.
authors: Samantha
authors: S
authors: Pulliam
authors: Department of Surgery, Pelvic Floor Disorders Service, Massachusetts General Hospital, Boston, MA. Electronic address: lbordeianou@partners.org.
authors: Liliana
authors: L
authors: Bordeianou
mesh_terms: D000328:Adult; D001676:Biofeedback, Psychology; D015897:Comorbidity; D003248:Constipation / Q000453:epidemiology* / Q000628:therapy*; D019841:Defecography; D004043:Dietary Fiber / Q000627:therapeutic use; D019468:Disease Management; D005260:Female; D006801:Humans; D007443:Intussusception / Q000453:epidemiology / Q000628:therapy; D008875:Middle Aged; D011446:Prospective Studies; D012002:Rectal Diseases / Q000453:epidemiology* / Q000628:therapy*; D020047:Rectocele / Q000453:epidemiology* / Q000628:therapy*; D012044:Regression Analysis; D013577:Syndrome; D016896:Treatment Outcome