Advertisement

Management of Associated Pelvic Dysfunctions: External Rectal Prolapse and Faecal Incontinence

  • Giuseppe Dodi
  • Luca Amadio

Abstract

Rectal prolapse syndrome (RPS) seems to be an appropriate term for a group of diseases in which rectal prolapse is just one of the signs, usually the most evident, but not necessarily the most annoying for the patient. External rectal prolapse is in itself a circumferential, full-thickness procidentia of the rectal wall through the anal orifice, a sliding hernia that develops in patients who often have a deep pouch of Douglas [1]. RPS includes several relatively well-defined clinical conditions in which full rectal prolapse, intussusception, mucosal prolapse, haemorrhoids, genital prolapse, descending or descended perineum, solitary rectal ulcer, weak pelvic floor muscles, faecal incontinence, hypertonic and nonrelaxing sphincters, constipation, “rather odd” personality (as stated by Goligher [2]) and eating disorders are variably associated. The nosographic setting of these conditions as a syndrome apparently has never been described in the medical literature.

Keywords

Pelvic Floor Faecal Incontinence Anal Sphincter Rectal Prolapse Anal Incontinence 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Moschcowitz AW (1912) The pathogenesis, anatomy and cure of prolapse of the rectum. Surg Gynecol Obstet 15:7–21Google Scholar
  2. 2.
    Goligher JC (1975) Surgery of the anus rectum and colon, 3rd end. Baillière Tindall, LondonGoogle Scholar
  3. 3.
    Mellgren A, Schultz I, Johansonn C, Dolk A (1997) Internal rectal intussusception seldom develops into total rectal prolapse. Dis Colon Rectum 40:817–820PubMedCrossRefGoogle Scholar
  4. 4.
    Ihre T, Seligson U (1975) Intussusception of the rectum-internal procidentia: treatment and result in 90 patients. Dis Colon Rectum 18:391–396PubMedCrossRefGoogle Scholar
  5. 5.
    Shafik A (1997) Role of pudendal canal syndrome in the etiology of faecal incontinence in rectal prolapse. Digestion 58:489–493PubMedCrossRefGoogle Scholar
  6. 6.
    Snooks SJ, Henry MM, Swash M (1985) Anorectal incontinence and rectal prolapse: differential assessment of the innervation to puborectalis and external anal sphincter muscles. Gut 26:470–476PubMedCrossRefGoogle Scholar
  7. 7.
    Williams JG, Wong WD, Jensen L et al (1998) Incontinence and rectal prolapse: a prospective manometric study. Dis Colon Rectum 41:1392–1398CrossRefGoogle Scholar
  8. 8.
    Damon H, Henry L, Roman S et al (2003) Influence of rectal prolapse on asymmetry of the anal sphinctere in patients with anal incontinence. BMC Gastroenterol 3:23PubMedCrossRefGoogle Scholar
  9. 9.
    Glasgow SC, Birnbaum EH, Kodner I et al (2006) Preoperative anal manometry predicts continence after perineal proctectomy for rectal prolapse. Dis Colon Rectum 49:1052–1058PubMedCrossRefGoogle Scholar
  10. 10.
    Woods R, Voyvodic F, Scholoithe AC et al (2002) Anal sphincter tears in patients with rectal prolapse and incontinence. Colorectal Dis 5:544–548CrossRefGoogle Scholar
  11. 11.
    Parks AG, Swash M, Urich H (1977) Sphincter denervation in anorectal incontinence and rectal prolapse 18:656–665Google Scholar
  12. 12.
    Neill ME, Parks AG, Swash M (1981) Physiological studies of the anal sphincter musculature in fecal incontinence and rectal prolapse. Br J Surg 68(8): 531–536PubMedCrossRefGoogle Scholar
  13. 13.
    Karulf RE, Madoff RD, Goldberg SM (2001) Rectal prolapse. Curr Probl Surg 38(10):771–832PubMedGoogle Scholar
  14. 14.
    Madiba TE, Baig MK, Wexner SD (2005) Surgical management of rectal prolapse. Arch Surg 140:63–23PubMedCrossRefGoogle Scholar
  15. 15.
    Mollen RM, Kuijpers HC, van Hoek F (2000) Effects of rectal mobilization and lateral ligaments division on colonic and anorectal function. Dis Colon Rectum 43:1283–1287PubMedCrossRefGoogle Scholar
  16. 16.
    Cavallari F, Dodi G (2004) Test della sfera solida: validazione metodologica e dati preliminari nella stipsi da anismo. Pelvi-Perineologia 23:132–135Google Scholar
  17. 17.
    Brown AJ, Anderson JH, McKee RF, Finlay IG (2004) Strategy for selection of type of operation for rectal prolapse based on clinical criteria. Dis Colon Rectum 47:103–107PubMedCrossRefGoogle Scholar
  18. 18.
    Portier G, Iovino F, Lezorthes F (2006) Surgery for rectal prolapse: Orr-Loygue ventral rectopexy with limited dissection prevents postoperative induced constipation without increasing recurrence. Dis Colon Rectum 49:1136–1140PubMedCrossRefGoogle Scholar
  19. 19.
    Lechaux D, Trebuchet G, Siproudhis L, Campion JP (2005) Laparoscopic rectopexy for full-thickness rectal prolapse. A single-institution retrospective study evaluating surgical outcome. Surg Endosc 19:514–518PubMedCrossRefGoogle Scholar
  20. 20.
    Tsunoda A, Yasuda N, Yokoyama N et al (2003) Delorme’s procedure for rectal prolapse. Clinical and physiological analysis. Dis Colon Rectum 46:1260–1265PubMedCrossRefGoogle Scholar
  21. 21.
    Marchal F, Bresler L, Ayav A et al (2005) Long-term results of Delorme’s procedure and Orr-Loygue rectopexy to treat complete rectal prolapse. Dis Colon Rectum 48:1785–1790PubMedCrossRefGoogle Scholar
  22. 22.
    Schultz I, Mellgren A, Dolk A et al (2000) Long-term results and functional outcome after Ripstein rectopexy. Dis Colon Rectum 43:35–43PubMedCrossRefGoogle Scholar
  23. 23.
    Aitola PT, Hiltunen KM, Matikainen MJ (1999) Functional results of operative treatment of rectal prolapse over an 11-year period. Emphasis on transabdominal approach. Dis Colon Rectum 42:655–660PubMedCrossRefGoogle Scholar
  24. 24.
    Zittel TT, Maniche K, Haug S et al (2000) Functional results after laparoscopic rectopexy for rectal prolapse. J Gastrointest Surg 4:632–641PubMedCrossRefGoogle Scholar
  25. 25.
    Benoist S, Taffinder N Gouls S et al (2001) Functional results two years after laparoscopic rectopexy. Am J Surg 182:168–173PubMedCrossRefGoogle Scholar
  26. 26.
    Pescatori M, Interisano A, Stolfi VM, Zoffoli M (1998) Delorme’s operation and sphincteroplasty for rectal prolapse and fecal incontinence. Int J Colorectal Dis 13:223–227PubMedCrossRefGoogle Scholar
  27. 27.
    Kohler A, Athanasiadis S (2001) The value of posterior levator repair in the treatment of anorectal incontinence due to rectal prolapse — a clinical and manometric study. Langenbeck’s Arch Surg 386:188–192CrossRefGoogle Scholar
  28. 28.
    Kim DS, Tsang CB, Wong WD et al (1999) Complete rectal prolapse: evolution of management and results. Dis Colon Rectum 42:460–469PubMedCrossRefGoogle Scholar
  29. 29.
    Johansen OB, Wexner SD, Daniel N et al (1993) Perineal rectosigmoidectomy in the elderly. Dis Colon Rectum 36:767–772PubMedCrossRefGoogle Scholar
  30. 30.
    Sainio AP, Vou tilainen PE, Husa AI (1991) Recovery of anal sphincter function following transabdominal repair of rectal prolapse: cause of improved continence? Dis Colon Rectum 34:816–821PubMedCrossRefGoogle Scholar
  31. 31.
    Roberts PL, Schoetz DJ, Coller JA et al (1988) Ripstein procedure: Lahey Clinic experience: 1963–1985. Arch Surg 123:554–557PubMedGoogle Scholar
  32. 32.
    Deen KI, Grant E, Billingham C, Keighley MR (1994) Abdominal resection rectopexy with pelvic floor repair versus perineal rectosigmoidectomy and pelvic floor repair for full-thickness rectal prolapse. Br J Surg 81(2):302–304PubMedCrossRefGoogle Scholar
  33. 33.
    Madoff RD, Williams JG, Wong WD et al (1992) Longterm functional results of colon resection and rectopexy for overt rectal prolapse. Am J Gastroenterol 87:1001–1004Google Scholar
  34. 34.
    Speakman CTM, Madden MV, Nicholls RJ, Kamm MA (1992) Lateral ligament division during rectopexy causes constipation but prevents recurrence of prolapse. Br J Surg 79(5):465Google Scholar
  35. 35.
    Boccasanta P, Venturi M, Barbieri S, Roviaro G (2006) Impact of new technologies on the clinical and functional outcome of Altemeier’s procedure: a randomized, controlled trial. Dis Colon Rectum 49:652–660PubMedCrossRefGoogle Scholar
  36. 36.
    Agachan F, Reissman P, Pfeifer J et al (1997) Comparison of three perineal procedure for the treatment of rectal prolapse. South Med J 90(9):925–932PubMedGoogle Scholar
  37. 37.
    Setti Carraro P, Nicholls RJ (1994) Postanal repair for faecal incontinence persisting after rectopexy. Br J Surg 81(2):305–307PubMedCrossRefGoogle Scholar
  38. 38.
    Matzel KE, Stadelmaier U, Hohenfellner M, Hohenberger W (2001) Chronic sacral spinal nerve stimulation for faecal incontinence: long-term results with foramen and cuff electrodes. Dis Colon Rectum 44:59–66PubMedCrossRefGoogle Scholar
  39. 39.
    Kenefick NJ, Vaizey CJ, Cohen RG et al (2002) Medium term results of sacral nerve stimulation for faecal incontinence. Br J Surg 89:896–901PubMedCrossRefGoogle Scholar
  40. 40.
    Jarrett MED, Matzel KE, Stosser M (2005) Sacral nerve stimulation for faecal incontinence following surgery for rectal prolapse repair: a multicenter study. Dis Colon rectum 48:1243–1248PubMedCrossRefGoogle Scholar
  41. 41.
    Altomare DF, Dodi G, La Torre F et al (2001) Multicentre retrospective analysis of the outcome of artificial anal sphincter implantation for severe faecal incontinence. Br J Surg 88(11):1481–1486PubMedCrossRefGoogle Scholar
  42. 42.
    Sanio AP, Halme LE, Husa AI (1991) Anal encirclement with polypropylene mesh for rectal prolapse and incontinence. Dis Colon Rectum 34(19):905–908CrossRefGoogle Scholar
  43. 43.
    Artibani W, Benvenuti F, Di Benedetto P et al (1996) Staging of female urinary incontinence and pelvic floor disorders. Proposal of IPGH system. Urodinamica, Neurology, Urodynamics & Continence 6(1):1–5Google Scholar
  44. 44.
    Dodi G, Lucio P, Spella M et al (2006) La raccolta dati nel paziente pelvi-perineologico. Pelvi-Perineologia 25:19–27Google Scholar
  45. 45.
    Farnsworth B, Dodi G (2007) Short-IPGH system for assessment of pelvic floor disease. Pelviperineology 26(2):73–77Google Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Giuseppe Dodi
    • 1
  • Luca Amadio
    • 1
  1. 1.Department of SurgeryUniversity of PaduaPaduaItaly

Personalised recommendations