RECTAL PROLAPSE AND RECTAL INVAGINATION

Solitary rectal ulcer, internal rectal intussusception, and complete r ectal prolapse are a range of defaecatory disorders that may have a co mmon aetiology, namely chronic straining. If the pelvic floor is weak, external prolapse is often complicated by faecal incontinence. Few pa tients, a lack of randomised trials, and difficulties in the interpret ation of studies of anorectal physiology (the results of which often s eem conflicting) have made the understanding of these disorders diffic ult. The basis for treatment is clear, however-patients who have sympt omatic defaecatory disorders associated with an internal intussuscepti on, or solitary rectal ulcer, or both should have a course of training of pelvic floor muscles, dietary advice, and should use fibre supplem ents as primary treatment. Operation should be reserved for those pati ents in whom medical treatment has failed, and it may be expected to r elieve symptoms in above two thirds of patients. Defaecating proctogra phy may be useful in assessing which patients may not benefit from ope ration. Operation is the primary treatment for external prolapse. The choice of surgical approach should be tailored according to the expert ise available, the medical condition of the patient, and the presence or absence of pre-existing constipation or incontinence.