Incidence of occult rectal prolapse in patients with clinical rectoceles and defecatory dysfunction.
OBJECTIVE
The purpose of this study was to determine the incidence of occult rectal prolapse (rectal intussusception) by defecating proctography in patients with clinical rectoceles and defecatory dysfunction.


METHODS
Patients who were seen from September 2000 through August 2001 with defecatory dysfunction and clinical rectoceles underwent single contrast defecating proctography. Radiologists who specialized in gastrointestinal fluoroscopy interpreted the results, which were retrieved from a computerized database. Study Design: Sixty patients who met the inclusion criteria were evaluated. Twenty patients (33%) had intussusception; 58 patients (97%) had rectocele; 1 patient (1.7%) had sigmoidocele, and 6 patients (10%) had anismus (paradoxic contraction of the puborectalis).


RESULTS
All but 1 case of intussusception was associated with a rectocele radiographically. Anismus was associated with rectoceles radiographically, except in 1 patient for whom it was the sole finding.


CONCLUSIONS
The data suggest a 33% incidence of occult rectal prolapse in patients with clinical rectoceles and defecatory dysfunction. This is highly clinically significant because one third of patients who are examined for defecatory dysfunction and rectocele may require sigmoid resection rectopexy along with other reconstructive procedures to restore pelvic floor function and prevent symptomatic recurrence.
Thompson
Jason R
JR
Department of Gynecologic Surgery, Mayo Clinic, Jacksonville, Fla, USA.
Chen
Anita H
AH
Pettit
Paul D m
PD
Bridges
Mellena D
MD
D003248:Constipation / Q000150:complications; D003672:Defecation; D005242:Fecal Incontinence / Q000150:complications; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D007443:Intussusception / Q000150:complications / Q000000981:diagnostic imaging; D011859:Radiography; D012005:Rectal Prolapse / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D020047:Rectocele / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery