title: Symptom distribution and anorectal physiology results in male patients with rectal intussusception and prolapse.
abstract: BACKGROUND
  Rectal intussusception and external rectal prolapse are uncommon proctographic findings in men reflecting the lack of studies investigating such patients. The aim of this study was to identify the demographic, clinical, and physiological characteristics of this population with a view to appreciate the mechanism of development of this condition.
  
  
  METHODS
  All men, presenting with symptoms of constipation or fecal incontinence, who were diagnosed proctographically with recto-rectal intussusception (RRI)/recto-anal intussusception (RAI) or external rectal prolapse (ERP) between 1994 and 2007 at a tertiary academic colorectal unit were studied. Demographics, relevant comorbidities, distribution and symptom duration, and anorectal physiology results were analyzed retrospectively for each proctographic group and intergroup comparisons performed.
  
  
  RESULTS
  Two hundred five men (median age 50 y; range, 13-86) including 155 (75.6%) without any relevant comorbidities were studied. A significant proportion of patients in all proctographic groups reported rectal evacuatory difficulty ([RRI, 46.4%], [RAI, 39.4%], [ERP, 44.8%]; P = 0.38,analysis of variance). Patients also reported a combination of fecal incontinence symptoms (e.g., urge, passive, postdefecatory leakage) that did not differ across the proctographic groups. Anorectal physiological parameters were within normal range and were not found to be statistically different between the proctographic groups with the exception of anal resting pressure, which was lowest in ERP patients (62 cm H2O; range, 14-155) compared with patients with RRI (89 cm H2O; range, 16-250; P = 0.003) and RAI (92 cm H2O; range, 38-175; P = 0.006).
  
  
  CONCLUSIONS
  Men with rectal intussusception and prolapse present with a combination of symptoms, predominantly defective rectal evacuation. Anorectal physiological assessment has failed to shed light into the mechanism of development of this condition and thus, the need for large observational studies incorporating integrated defecographic and manometric assessments of the evacuation process.
authors.affiliation: Academic Surgical Unit, Centre for Digestive Diseases, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University London, Whitechapel, London, UK. Electronic address: alex007@doctors.org.uk.
authors.forename: Alexander
authors.initials: A
authors.lastname: Hotouras
authors.affiliation: Academic Surgical Unit, Centre for Digestive Diseases, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University London, Whitechapel, London, UK.
authors.forename: Jamie
authors.initials: J
authors.lastname: Murphy
authors.affiliation: Academic Surgical Unit, Centre for Digestive Diseases, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University London, Whitechapel, London, UK.
authors.forename: Aliza
authors.initials: A
authors.lastname: Abeles
authors.affiliation: Academic Surgical Unit, Centre for Digestive Diseases, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University London, Whitechapel, London, UK.
authors.forename: Marion
authors.initials: M
authors.lastname: Allison
authors.affiliation: Academic Surgical Unit, Centre for Digestive Diseases, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University London, Whitechapel, London, UK.
authors.forename: Norman S
authors.initials: NS
authors.lastname: Williams
authors.affiliation: Academic Surgical Unit, Centre for Digestive Diseases, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University London, Whitechapel, London, UK.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Knowles
authors.affiliation: Academic Surgical Unit, Centre for Digestive Diseases, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University London, Whitechapel, London, UK.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000000981:diagnostic imaging; D015897:Comorbidity; D003248:Constipation / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007443:Intussusception / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012005:Rectal Prolapse / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: External rectal prolapse; Male patients; Rectal intussusception