Aim: To evaluate functional outcome of transperineal (TP) versus transrectal (TR) repair of rectocele presented with 
obstructed defecation. 
Methods: 48 multiparous females with obstructed defecation due to rectocele were randomly allocated into 3 groups: Group A (16 patients): TP repair with levatorplasty (LP).Group B (16): TP repair without LP.Group C (16): TR repair. The study included defecographic assessment, anal manometry {Maximum anal resting pressure (MARP), maximum reflex volume (MRV) and urge to defecate volume (UTDV) and functional score (0 –26). These were done preoperative and 6 months postoperative. 
Results: Defecography showed significant reduction in size of rectocele in all groups. Constipation improved significantly in the groups of transperineal but not in transrectal repair. We had significant reduction in MARP, UTDV and MRV only in 
transperineal approach. Functional score was significantly improved in group A (P<0.001) and B (P<0.001) while the 
improvement was insignificant in group C. LP significantly improved the overall functional score in group A compared to 
group B and C (P= 0.032) 
Conclusions: Rectocele repair improves anorectal function by improving the rectal urge sensitivity. TP repair of rectocele is superior to TR repair in both the structural and functional outcome. Levatorplasty improves functional outcome, but should be avoided in young sexually active females.