Abstract: Objective To evaluate the results of anorectal dynamics in patients with severe rectocele. Methods A retrospective analysis was conducted on the clinical data of 38 patients definitively diagnosed with severe rectocele at the pelvic floor center of the anorectal department of Nanjing Hospital of Traditional Chinese Medicine from January 2020 to January 2023. All patients underwent anorectal manometry, and the results of anorectal dynamics were analyzed. Results A total of 15 patients (39.47%) had elevated anal resting pressure (ARP), 20(52.63%) had normal ARP, and 3(7.89%) had decreased ARP. Five patients (13.16%) had elevated maximum anal sphincter pressure (MASP), 9(23.68%) had normal MASP, and 24(63.16%) had decreased MASP. Normal defecation relaxation reflex was observed in 15 patients (39.47%), and abnormal defecation relaxation reflex was observed in 23 patients (60.53%). Ten patients (26.32%) had normal rectal defecation pressure, and 28(73.68%) had decreased rectal defecation pressure. Eleven patients (28.95%) had elevated rectal initial sensory threshold (RIST), 27(71.05%) had normal RIST. Fifteen patients (39.47%) had elevated rectal defecation sensory threshold, 21(55.26%) had normal rectal defecation sensory threshold, and 2(5.26%) had decreased rectal defecation sensory threshold. Three patients (7.89%) had elevated rectal maximum tolerable volume, 26(68.42%) had normal rectal maximum tolerable volume, and 9 (23.68%) had decreased rectal maximum tolerable volume. ARP was moderately positively correlated with the chronic constipation severity (CSS) score (P=0.007, r=0.429), and abnormal defecation relaxation reflex was moderately negatively correlated with the CSS score (P=0.019, r=-0.329). In 3 patients (7.89%), both ARP and MASP were decreased, and both ARP and MASP were elevated in 5 patients (13.16%). Conclusion Preoperative anorectal dynamics analysis is necessary for patients with severe rectocele to formulate a reasonable individualized surgical plan and postoperative rehabilitation program.