Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome

context: management of patients with obstructed defecation syndrome is still controversial. objective: to analyze the efficacy of clinical, clinical treatment followed by biofeedback, and surgical treatment in patients with obstructed defecation, rectocele and multiple dysfunctions evaluated with echodefecography. methods: the study included 103 females aged 26-84 years with obstructed defecation, grade-ii/iii rectocele and multiple dysfunctions on echodefecography. patients were distributed into three treatment groups and constipation scores were assigned. group i: 34 (33%) patients with significant improvement of symptoms through clinical management only. group ii: 14 (14%) with improvement through clinical treatment plus biofeedback. group iii: 55 (53%) referred to surgery due to treatment failure. results: group i: 20 (59%) patients had grade-ii rectocele, 14 (41%) grade-iii. obstructed defecation syndrome was associated with intussusception (41%), mucosal prolapse (41%), anismus (29%), enterocele (9%) or 2 dysfunctions (23%). the average constipation score decreased significantly from 11 to 5. group ii: 11 (79%) grade-ii rectocele, 3 (21%) grade-iii, associated with intussusception (7%), mucosal prolapse (43%), anismus (71%) or 2 dysfunctions (29%). there was significant decrease in constipation score from 13 to 6. group iii: 8 (15%) grade-ii rectocele, 47 (85%) grade-iii, associated with intussusception (42%), mucosal prolapse (40%) or 2 dysfunctions (32%). the constipation score remained unchanged despite clinical treatment and biofeedback. twenty-three underwent surgery had a significantly decrease in constipation score from 12 to 4. the remaining 32 (31%) patients which 22 refused surgery, 6 had low anal pressure and 4 had slow transit. conclusions: approximately 50% of patients with obstructed defecation, rectocele and multiple dysfunctions presented a satisfactory response to clinical treatment and/or biofeedback. surgical repair was mainly required in pa