Many women have rectoceles, but not all of them need repair. Generally speaking, large rectoceles greater than 4 cm on defecating proctogram and/or the need to digitally support the back wall of the vagina or perineal body to expel stool are good indicators of those needing repair. Patients have usually been started on a high-fiber diet and have continued problems before considering repair. In my practice, I find working from the vaginal aspect is the most beneficial for the patient. This is usually the urologist, gynecologist, or urogynecologist. Many times, an unanticipated enterocele is found. The symptoms from the ente-rocele may be overlooked and become more evident when the rectocele is eliminated.

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