Study No. 12: Role of the uterosacral ligaments in the causation of rectal intussusception, abnormal bowel emptying, and fecal incontinence. A prospective study

The aim of this study was to assess the role of damaged uterosacral ligaments and associated rectovaginal fascia in the causation of rectocele, rectal intussusception, evacuation disorders and fecal incontinence. METHODS: 48 patients with various degrees of vaginal vault descensus, clinical rectoceles and defecatory dysfunctions were treated by insertion of a posterior IVS (syn: infracoccygeal sacropexy), reconstruction of the rectovaginal fascia and perineal body repair. RESULTS: Of the 48 patients with evacuation difficulties, 45 (94%) patients reported complete normalization of defecation at both visits after surgery. Of the 27 patients with fecal incontinence, 18 (66%) reported cure, 5 (19%) >50% improvement, and 4 no change. Postoperative proctograms showed resolution of the rectal intussusception in 89% and 94% reported completely normal defecation after surgery. CONCLUSIONS: Connective tissue damage to the anterior rectal wall supports may cause it to sag inwards, “intussusception”. The posterior sling creates a foreign body reaction which reinforces the damaged uterosacral ligament and “reglues” the ligament’s attachments to levator plate, cervical ring and rectovaginal fascia to suspend and stretch the rectal wall.