Piles and rectoceles.

Symptomatic rectocele is known to contribute to the formation of piles in female patients. This paper describes a subset of women pile sufferers who have occult rectoceles which are asymptomatic, and which are not obvious on routine visual examination, even with the use of the speculum. These patients are multiparous and have sustained perineal damage either from episiotomy or from laceration. They present with symptoms of piles. If treated by conventional pile surgery the postoperative course is bedevilled with difficult defaecation, the patient often needing to insert a finger into the vagina to gain satisfactory evacuation. An accurate case history will show all these patients to have a preoperative story of straining at stool. Anterior rectal wall pressure on rectal examination shows a definite occult rectocele (spinnaker deformity) coupled with a deficient scarred perineum. This paper describes 15 such patients who have been seen over the past 4 years. Treatment has been by either pile surgery and later colpoperineorrhaphy (four cases), by combined colpoperineorrhaphy and pile surgery (eight cases), or by surgical correction of the rectocele alone (three cases).