Post-operative results are variable. Some rectoceles might be caused by a paradoxical puborectalis contraction leading to an outlet obstruction and to disappointing surgical results [1]. Thus, an anorectal physiologic study including anal sponge (anal plug) electromyography should be performed for excluding non-relaxing puborectalis syndrome [2]. In that case, biofeedback therapy should be applied first. A vital point for a good post-operative result is the tightness (strength) of the reconstructed rectovaginal septum even though long-term post-operative results aredisappointing [3]. A larger decrease in the rectocele diameter means greater strength of the rectovaginal septum.