High-grade internal rectal prolapse: Does it explain so-called “idiopathic” faecal incontinence?

Abstract

High-grade internal rectal prolapse is common in female patients suffering particularly urge faecal incontinence, without anal sphincter lesions. Defecation proctography should be routine in the work up of faecal incontinence.

International Continence Society best practice statement for use of sacral neuromodulation

“…It is usually done before surgical decision‐making, as part of the FI work‐up and plays a role to guide pelvic floor retraining. Endoanal ultrasound is the recommended tool to assess the anal sphincter complex and to identify any sphincter defects. It would guide the discussion to proceed for repair versus SNM trial according to the different aspects of the defect. Dynamic defecography, either standard or MRI, is nowadays also a test to consider prior to SNM trial . This exam allows for identification of any posterior pelvic floor disorder including high‐grade rectal intussusception, which can be clinically difficult to identify and a potential cause of FI.…”

“…Dynamic defecography, either standard or MRI, is nowadays also a test to consider prior to SNM trial. 86 This exam allows for identification of any posterior pelvic floor disorder including high-grade rectal intussusception, which can be clinically difficult to identify and a potential cause of FI. In such a case, many clinicians would first correct the rectal prolapse followed by an SNM trial if FI persists.…”

Anal encirclement using polypropylene mesh for high grade complete full-thickness rectal prolapse: A case report

“…There are many surgical techniques used to treat prolapse rectum, which are generally divided into two approaches, namely the abdominal and the perineal approaches. The ultimate goals of therapy are to prevent recurrence, restore defecation function, and prevent constipation or incontinence [[11], [12], [13]]. Some authors recommend the use of an abdominal approach in younger rectal prolapse patients, because patients can tolerate general anesthesia, and use the perineal approach in the elderly high-risk population [3].…”

Rectoanal intussusception is very common in patients with fecal incontinence

“…However, in the present study a higher incidence of RAI was seen in patients with not only FI and OD (79%), but also FI alone (72%). Bloemendaal et al 24) reported that half of the patients with FI alone, without anal sphincter defect, demonstrated RAI. It is difficult to determine the clinical significance of RAI.…”