Original Article

International Urogynecology Journal

, Volume 19, Issue 5, pp 705-710

First online:

The surgical anatomy of rectocele and anterior rectal wall intussusception

  • B. AbendsteinAffiliated withDepartment of Obstetrics and Gynecology, Bezirkskrankenhaus
  • , P. E. P. PetrosAffiliated withRoyal Perth Hospital and University of Western Australia Email author 
  • , P. A. RichardsonAffiliated withGallier’s Hospital
  • , K. GoeschenAffiliated withFacharzt für Frauenheilkunde, University of Hannover
  • , D. DoderoAffiliated withDepartment of Obstetrics and Gynecology, University of Genoa

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The aim of the study was to analyse the dynamic anatomical supports of the posterior vaginal wall from the perspective of rectocele and rectal intussusception repair. Two groups of patients were studied. Group 1 (n = 24) with genuine stress incontinence but no major vault prolapse had vagino/proctomyograms and transperineal ultrasound examinations. Group 2 with vaginal vault prolapse, clinical rectoceles and obstructive defecation symptoms (n = 19 had single-contrast defecating proctography before and after posterior-sling surgery. The posterior vaginal wall is suspended between perineal body, which underlies half its length, and uterosacral ligaments, which also support the anterior wall of rectum. Muscle forces stretch the vagina and rectum against the perineal body and uterosacral ligaments, creating shape and strength, like a suspension bridge. Postoperative proctogram studies indicated that anterior rectal wall intussusception has the same etiology as rectocele, deficient recto-vaginal ligamentous support. Repair to uterosacral ligaments and perineal body should be considered with large rectoceles, anterior rectal wall intussusception and obstructive defecation disorders.


Rectocele anatomy Rectal intussusception Perineal body Uterosacral ligaments