BACKGROUND/AIMS: The aim of this study is to evaluate defecographic and anorectal manometric findings in patients with rectocele and to identify associated pelvic floor findings. METHODS: We reviewed defecography in 90 patients (all females;mean age, 44.7 years) with rectocele, who were collected from 427 patients who underwent defecography. We also reviewed a colon transit time study, and an anorectal manometry examination. 56 healthy volunteers (mean age 36.5, female 30, male 26) were studied. RESULTS: In the patient group, the depth of rectocele was 2.92+/-0.89 cm, while in the control group, it was 1.62+/- 0.66 cm (p value < 0.001). The mean rest, squeezing, and straining centroid anorectal angle(degrees) in both groups were: 99.7+/-19.3 vs. 126.2+/-19.3; 120.4+/-15.8 vs. 111.5+/-18.9; 132.2+/-14.6 vs. 141.0+/-15.7 (p < 0.05). The mean pelvic floor descent(cm) during rest, squeezing and straining were: 5.90+/-1.26 vs. 5.08+/-1.28 (p < 0.01); 4.89+/- 1.17 vs. 3.65+/-1.13(p < 0.01); 8.61+/-1.6 vs. 7.27+/-1.39(p < 0,001). In 60 of the 90 patients with rectocele, the mean barium trap was 32.7% after defecation. The mean maximal anal resting pressure and squeezing pressure(mmHg) in both groups were: 85.8+/-25.3 vs 47.1+/-9.3(p < 0.01); 138.9+/-35.14 vs. 92.7+/-28.1(p < 0.01). The mean anal canal was opened to 2.52cm in patients with rectocele and to 2.47cm in control subjects during defecation. Associated findings were a pelvic spastic syndrome in 16, pelvic descent syndrome in 37, rectoanal intussusception in 37 and rectal prolapse in 4 of the patients. Colon transit time was more prolonged in the patient group than the control group. CONCLUSIONS: Rectocele may be associated with various pelvic floor diseases. Careful preoperative investigations are important before surgical treatment of rectocele.