Rectal Prolapse, Rectal Intussusception, Rectocele, Solitary Rectal Ulcer Syndrome, and Enterocele

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Rectal prolapse is best diagnosed by physical examination and by having the patient strain as if to defecate; a laparoscopic rectopexy is the preferred treatment approach. Intussusception is more an epiphenomena than a defecatory disorder and should be managed conservatively. Solitary rectal ulcer syndrome is a consequence of chronic straining and therapy should be aimed at restoring a normal bowel habit with behavioral approaches including biofeedback therapy. Rectocele correction may be considered if it can be definitively established that it is a cause of defecation disorder and only after conservative measures have failed. An enterocele should only be operated when pain and heaviness are predominant symptoms and it is refractory to conservative therapy.

Section snippets

Definition, Etiology, and Pathogenesis

A complete rectal prolapse is defined as the protrusion of all layers of the rectal wall through the anal canal. If the rectal wall prolapses but does not protrude through the anus it is called an ā€œoccult rectal prolapseā€ or a ā€œrectal intussusception.ā€ A rectal prolapse should be distinguished from a mucosal prolapse; in the latter there is only protrusion of the rectal or anal mucosa. The incidence of rectal prolapse is approximately 2.5 per 100,000 inhabitants,1 with a highest incidence among

Definition, Etiology, and Pathogenesis

Rectal intussusception, occult rectal prolapse, or internal procidentia is an intussusception of the rectal wall that does not protrude through the anus and can be classified into high-grade (intrarectal) and low-grade (intra-anal) intussusception based on the level of mucosa protruding.47 Although it is associated with solitary rectal ulcer, rectal prolapse, or perineal descent, the finding per se is not pathologic. In 50% to 60% of healthy volunteers a rectal intussusception can be

Definition, Etiology, and Pathogenesis

SRUS was first described in 1830 by Cruveilhier, but was recognized as a clinical entity in 1969 by Madigan and Morson.65 The estimated annual incidence is 1 to 3.6 per 100,000.66 About 80% of patients are less than 50 years. Gender distribution is either equal or there is a slight female preponderance.66 The mean age of presentation is 49Ā years, and about 25% present after 60 years.67 The condition is associated with an evacuation disorder. Defecography has shown that an intussusception is

Definition, Etiology, and Pathogenesis

A rectocele is a protrusion of the anterior rectal wall usually toward the vagina. Weakness of the pelvic floor leads to a deficiency in the rectovaginal septum (the fascia of Denonvilliers, which is continuous with the perineal body) (Fig.Ā 7). Deficiency in the upper half of the septum produces a high rectocele, and that of the lower half a low rectocele. A rectocele can be classified as low, midvaginal, or high according to the new standardized terminology.85

Obstetric injury is the major

Definition, Cause, Pathogenesis

Enterocele is defined as a peritoneum-lined sac herniating down between the vagina and rectum filled with abdominal content, often the small bowel.113 It was first reported in 1932 and considered a rare clinical entity, until in 1973 after a larger series was presented114 the phenomena became more known in the gynecologic literature. With the increasing interest in dyssynergic defecation gastroenterologists and colorectal surgeons have focused more on pelvic floor abnormalities.115 The

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