Background: Transvaginal repair (TVR) is a well-established approach for the repair of the anterior rectocele and exhibits good results regarding recurrence rates and symptomatology. A previous study suggested that the injection of botulinum toxin (BTX) into the anal sphincter complex successfully managed rectocele due to obstructed defecation syndrome (ODS). This study aimed to study the effect of simultaneous BTX injection with TVR of rectocele on the incidence of recurrence. Methods: Data from female patients who had transvaginal repair of anterior rectocele and botulinum toxin injection in puborectalis muscle (TVR + BTX) were retrospectively collected. The incidence of recurrence was recorded in addition to the assessment of clinical symptoms, defecatory function, sexual function, and quality of life (QOL). Results: Data from 20 female patients (mean age = 43.9 ± 12.8) were included. In a 12-month follow-up, no cases reported recurrence of symptoms. Also, at postoperative 12 months, patients showed better constipation score (from 14.5 ± 1.7 to 6.3 ± 2.6, P<0.0001) and sexual function score (from 28.6 ± 2.2 to 39.9 ± 2.5, P<0.0001). Moreover, the patients showed better results regarding the symptoms and the quality of life scores. Median pain score remained ≥ 3 up to the first week of follow-up, then no significant pain was reported in the following follow-up dates. Conclusion: The application of TVR + BTX resulted in zero incidence of recurrence and the addition of BTX injection to TVR probably resulted in better defecatory function, sexual function and QOL.