Assessing Rectocele Depth and Its Association with Symptoms of Pelvic Floor Disorders Using Transperineal Ultrasound

Aim We investigated the clinical features of symptomatic rectoceles, as measured by transperineal ultrasound (TPUS), and evaluated the association between rectocele size and the clinical symptoms of pelvic floor disorders. Method This was a retrospective study using data obtained at a pelvic floor centre between August 2020 and January 2021. A total of 125 patients with defaecation disorders, such as constipation and faecal incontinence, were included. The preoperative questionnaire included the Cleveland Clinic Constipation Scoring System (CCCS, Wexner constipation score), Cleveland Clinic Incontinence Score (CCIS, Wexner incontinence score), faecal incontinence severity index (FISI), and faecal incontinence quality of life (FIQOL) scale. The size of the rectocele was measured on the trans-perineal 2D images. Patients were assigned to three groups based on rectocele size: no rectocele (<10 mm), ≥10 mm rectocele, and ≥15 mm rectocele. Results In the study population, 43 participants (34.4%) had no rectocele, 50 (40.0%) had ≥10 mm rectocele, and 32 (25.6%) had ≥15 mm rectocele. From the no rectocele to ≥15 mm rectocele group, the scores for the symptoms of incontinence and constipation increased, and the quality of life worsened. The CCIS (6.00±4.95 vs 8.62±5.77 vs 11.08±5.63, P = 0.004), FIQOL (13.72±4.19 vs 13.42±4.35 vs 10.38±3.88, P = 0.006), FISI (18.83±17.67 vs 25.15±17.34 vs 33.42±15.49, P = 0.010), and CCCS (7.50±6.26 vs 8.65±5.31 vs 13.11±5.90, P = 0.006), respectively. Conclusion The TPUS was a valuable method for the anatomical evaluation of symptomatic rectocele. The larger the size of the symptomatic rectocele measured using TPUS, the more severe the clinical symptoms.