title: Does the presence of a high grade internal rectal prolapse affect the outcome of pelvic floor retraining in patients with faecal incontinence or obstructed defaecation?
abstract: OBJECTIVE
  Pelvic floor retraining is considered first-line treatment for patients with faecal incontinence or obstructed defaecation. There are at present no data on the effect of a high grade internal rectal prolapse on outcomes of pelvic floor retraining. The current study aimed to assess this influence.
  
  
  METHODS
  In all, 120 consecutive patients were offered pelvic floor retraining. The predominant symptom was faecal incontinence in 56 patients (47%) and obstructed defaecation in 64 patients (53%). Patients were assessed before and after therapy using the Fecal Incontinence Severity Index (FISI), the Patient Assessment of Constipation Symptoms (PAC-SYM) score and the Gastrointestinal Quality of Life Index (GIQLI). Defaecography and anorectal manometry were performed in all patients before pelvic floor retraining.
  
  
  RESULTS
  A high grade internal rectal prolapse was observed in 42 patients (35%). In patients with faecal incontinence without a high grade internal rectal prolapse, the FISI score decreased from 36 to 27 (P < 0.01). The FISI score did not change (32 vs 32; P = 0.93) in patients with a high grade internal rectal prolapse. The PAC-SYM score improved significantly (24 vs 19; P = 0.01) in patients with obstructed defaecation without a high grade rectal prolapse compared with no significant change (26 vs 25; P = 0.21) in patients with a high grade rectal prolapse. Quality of life (GIQLI) improved only in patients without a high grade internal rectal prolapse.
  
  
  CONCLUSIONS
  Pelvic floor retraining may be useful in patients with defaecation disorders not associated with a high grade internal rectal prolapse. Patients with a high grade internal rectal prolapse may be considered for surgery from the outset.
authors.affiliation: Oxford Pelvic Floor Centre, Department of Colorectal Surgery, Churchill Hospital, Oxford, UK.
authors.forename: S
authors.initials: S
authors.lastname: Adusumilli
authors.forename: M P
authors.initials: MP
authors.lastname: Gosselink
authors.forename: S
authors.initials: S
authors.lastname: Fourie
authors.forename: K
authors.initials: K
authors.lastname: Curran
authors.forename: O M
authors.initials: OM
authors.lastname: Jones
authors.forename: C
authors.initials: C
authors.lastname: Cunningham
authors.forename: I
authors.initials: I
authors.lastname: Lindsey
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000503:physiopathology; D003672:Defecation / Q000502:physiology; D019841:Defecography; D005081:Exercise Therapy; D005242:Fecal Incontinence / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D017773:Pelvic Floor / Q000503:physiopathology*; D011788:Quality of Life; D012005:Rectal Prolapse / Q000150:complications*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Constipation; biofeedback; faecal incontinence; internal rectal prolapse; obstructed defaecation