title: High-grade internal rectal prolapse: Does it explain so-called "idiopathic" faecal incontinence?
abstract: BACKGROUND
  Faecal incontinence is a multifactorial disorder, with multiple treatment options. The role of internal rectal prolapse in the aetiology of faecal incontinence is debated. Recent data has shown the importance of high-grade internal rectal prolapse in case of faecal incontinence. We aimed to determine the incidence and relevance of internal rectal prolapse in patients with faecal incontinence without an anal sphincter defect.
  
  
  METHODS
  Patient data, collected in a prospective pelvic floor database, were assessed. All females with moderate to severe pure faecal incontinence, without obstructed defecation and sphincter muscle defects, were included. Data on defecation proctography, anorectal physiology and incontinence scores were analysed.
  
  
  RESULTS
  Of 2082 females in the database, 174 fitted the inclusion criteria. High-grade internal rectal prolapse was found in 49% of patients and was associated predominantly with urge faecal incontinence. Passive faecal incontinence was more common in low-grade compared to high-grade internal rectal prolapse patients. Maximum resting pressure was lower in older patients and in patients with high-grade compared to low-grade internal rectal prolapse. Internal rectal prolapse grade was not significantly correlated with faecal incontinence severity score.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, United Kingdom. Electronic address: alexander.bloemendaal@ouh.nhs.uk.
authors.forename: A L A
authors.initials: AL
authors.lastname: Bloemendaal
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, United Kingdom.
authors.forename: N C
authors.initials: NC
authors.lastname: Buchs
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Prapasrivorakul
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, United Kingdom.
authors.forename: C
authors.initials: C
authors.lastname: Cunningham
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, United Kingdom.
authors.forename: O M
authors.initials: OM
authors.lastname: Jones
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, United Kingdom.
authors.forename: R
authors.initials: R
authors.lastname: Hompes
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, United Kingdom.
authors.forename: I
authors.initials: I
authors.lastname: Lindsey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology; D016208:Databases, Factual; D003672:Defecation; D019841:Defecography; D005242:Fecal Incontinence / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012005:Rectal Prolapse / Q000150:complications* / Q000473:pathology; D012720:Severity of Illness Index
keywords: Anorectal physiology; Faecal incontinence; Internal rectal prolapse; Proctography