Prospective Randomized Controlled Trial of Obstructed Defecation Surgery

Inclusion Criteria:

1. Female, between the age of 18 and 80

2. OD symptoms as indicated by an affirmative response to either questions 7, 8 or 14of the Pelvic Floor Distress Inventory (PFDI):

3. Do you feel you need to strain too hard to have a bowel movement?

4. Do you feel you have not completely emptied your bowels at the end of a bowelmovement?

5. Does part of your bowel ever pass through the rectum and bulge outside duringor after a bowel movement?

6. Rectal hypermobility defined as a compression ratio greater than 50% according toultrasound

7. Patient planning on undergoing surgery for the repair of pelvic organ prolapsewithin the next 12 months

8. Patient who is not pregnant and does not intend to become pregnant in the next 2years

9. Available for 24-months of follow-up

10. Stated willingness to comply with all study procedures and availability for theduration of the study

11. Able to complete study assessments, per clinician judgment

12. Able and willing to provide independent written informed consent

13. Stable cardiovascular and respiratory status to meet candidacy in vaginal orlaparoscopic surgeries

Exclusion Criteria:

1. Contraindication to abdominal and transvaginal rectopexy in the opinion of thetreating surgeon

2. History of previous surgery that included any type of surgery for rectal prolapse

3. Pelvic pain or dyspareunia due to levator ani spasm that would preclude a PMTprogram

4. Previous adverse reaction to synthetic mesh

5. Current cytotoxic chemotherapy or current or history of pelvic radiation therapywithin 12 months

6. History of two inpatient hospitalizations for medical comorbidities in the previous 12 months