Rectocele Repair with or Without Internal Sphincter Botulinum Toxin Injection: a Prospective Randomized Trial

Inclusion Criteria: all required * female patients * symptomatic rectocele * failed conservative treatments for at least 3 months * anterior rectocele larger than 3 cm in size in defecogram. * retention of the contrast in the rectocele on defecography * obstructed defecation manifestations: excessive straining, a sense of incomplete evacuation, the need for digital manipulation during defecation, or dyspareunia Exclusion Criteria: * significant urinary manifestations due to anterior vaginal wall prolapse * recurrent rectocele * previous anal surgery * slow-transit constipation * faecal incontinence (FI) * abnormal thyroid functions * patients under systemic steroid treatment * patients with connective tissue disease * ASA classification \>3