부산대학교 도서관

Rectocele is a primary cause of intractable obstructed defecation, but the role of the rectocele is controversial. The aim of this study was to identify the factor having the greatest influence on the laxity of the rectovaginal septum. A total of 635 female patients were studied. Information on age, body weight, height, bowel frequency, laxative use, and number of vaginal deliveries was obtained by questionnaire. Laxity of the rectovaginal septum was assessed by rectal digital examination, and the patients were divided into two groups; negative or positive for rectocele. Anorectal symptoms were present in 63% of the patients with rectocele, and in 34% of the patients without rectocele, and the differences were significant (P=0.001). The frequency of rectocele increased significantly as the number of vaginal deliveries increased. Multivariate analysis revealed that age, physique, and bowel habits have little influence on laxity of the rectovaginal septum, but that the presence of anorectal symptoms, and the number of vaginal deliveries, have a major effect on it. Twenty-five patients with large rectoceles in our series had no symptoms of defecation difficulty, and none of the 7 patients who complained of defecation difficulty had large rectoceles. Our results suggested that laxity of the rectovaginal septum is closely related to vaginal delivery, but the etiology of symptomatic rectocele depends not only on the size of the bulge but on the presence of other anorectal conditions.