Materiały źródłowe

• #1 Rectal Prolapse

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3140332/

  Rectal prolapse is a condition that usually requires surgical intervention to correct. […] The exact cause and mechanism of rectal prolapse is not completely understood. Numerous possibilities have been proposed. Rectal prolapse may be seen in childhood suggesting a congenital defect in the pelvic connective tissue or sphincter musculature. […] Pregnancy, obesity, perineal injury, chronic constipation, or other conditions resulting in increased intra-abdominal pressure are associated with rectal prolapse. Anatomic variations, such as a deep cul-de-sac of Douglas and redundant sigmoid colon, are frequently associated with the condition and may be causal.

• #2 Rectal Prolapse: Pathophysiology | SpringerLink

  https://link.springer.com/chapter/10.1007/978-88-470-0684-3_2

  Rectal prolapse, procidentia, complete prolapse or first-degree prolapse, is defined as a circumferential, full-thickness intussusception of the rectal wall with protrusion beyond the anal canal. This definition emphasises two important points: (1) rectal prolapse is the expression of a full-thickness intussusception, and (2) protrusion is outside the anus. The cause of rectal prolapse is still not completely understood. It is likely the result of a multifactorial aetiology, and any single standard theory would be improbable and imprecise. This implies that each patient potentially has his or her own specific pathogenetic profile, which is the result of a mix of several aetiological factors. […] A great division has developed between supporters of the sliding hernia and those who support the rectal intussusception theory. Rectal prolapse has been related to either a form of sliding hernia, as most patients have a redundant sigmoid colon, deep pelvic-peritoneal cul-de-sac, diastasis of the levator ani muscles, loss of posterior rectal fixation and loss of the usual anorectal angle; or to the final stages of a progressively worsening intussusception, as similarities in manometric findings can be found among patients with rectal prolapse, rectoanal intussusception and solitary rectal ulcer syndrome.

• #3 The aetiology and pathogenesis of rectal prolapse – ORA – Oxford University Research Archive

  https://ora.ox.ac.uk/objects/uuid:ff820a2b-48a6-4a5c-92c7-e7d2fdc22e95

  It is still an enigma that some patients develop rectal prolapse whilst others with similar risk factors do not. […] Biomechanical assessment of the skin may provide further insight into the aetiology of this complex condition. […] Components of connective tissue other than collagen have been found to be involved in patients with rectal prolapse. […] Elastin fibres are an abundant and integral part of many extracellular matrices and are especially critical for providing the property of elastic recoil.

• #4 Rectal Prolapse: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/2026460-overview

  The pathophysiology of rectal prolapse is not completely understood or agreed upon. There are two main theories, which essentially are different ways of expressing the same idea. […] The first theory postulates that rectal prolapse is a sliding hernia through a defect in the pelvic fascia. The second theory holds that rectal prolapse starts as a circumferential internal intussusception of the rectum beginning 6-8 cm proximal to the anal verge. With time and straining, this progresses to full-thickness rectal prolapse, though some patients never progress beyond this stage. […] The pathophysiology and etiology of mucosal prolapse most likely differ from those of full-thickness rectal prolapse and internal intussusception. Mucosal prolapse occurs when the connective tissue attachments of the rectal mucosa are loosened and stretched, thus allowing the tissue to prolapse through the anus. This often occurs as a continuation of long-standing hemorrhoidal disease and is treated as such. […] Often, prolapse begins with an internal prolapse of the anterior rectal wall and progresses to full prolapse.

• #5 Rectal prolapse – Wikipedia

  https://en.wikipedia.org/wiki/Rectal_prolapse

  A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. […] The precise cause is unknown, and has been much debated. […] In 1912 Moschcowitz proposed that rectal prolapse was a sliding hernia through a pelvic fascial defect. […] Shortly after the invention of defecography, In 1968 Broden and Snellman used cinedefecography to show that rectal prolapse begins as a circumferential intussusception of the rectum, which slowly increases over time. […] Since most patients with rectal prolapse have a long history of constipation, it is thought that prolonged, excessive and repetitive straining during defecation may predispose to rectal prolapse. […] The assumed mechanism of fecal incontinence in rectal prolapse is by the chronic stretch and trauma to the anal sphincters and the presence of a direct conduit (the intussusceptum) connecting rectum to the external environment which is not guarded by the sphincters.

• #6 Rectal Prolapse, Rectal Intussusception, Rectocele, Solitary Rectal Ulcer Syndrome, and Enterocele | Abdominal Key

  https://abdominalkey.com/rectal-prolapse-rectal-intussusception-rectocele-solitary-rectal-ulcer-syndrome-and-enterocele/

  In the elderly patient with a rectal prolapse both a weak pelvic floor and a mobile rectum are present. Straining over many years (caused by longstanding constipation) is believed gradually to weaken the pelvic floor causing pudendal nerve damage, and this in turn may lead to weakness of the internal and external anal sphincters. These pathophysiologic changes facilitate protrusion of the rectal wall through the anus. Furthermore, pudendal neuropathy caused by either aging or obstetric injury may play a role. […] There are two theories regarding the development of rectal prolapse. In 1912, Moschcovitz proposed that a deep pouch of Douglas may allow the small bowel to protrude into the lower anterior rectal wall. This protrusion together with a mobile mesorectum and mesosigmoid may allow the development of a rectal prolapse. In 1968, Broden and Snellman used cinematography and suggested that intussusception from the rectosigmoid region was the main cause.

• #7 Surgical Treatment of Rectal Prolapse

  https://coloproctol.org/journal/view.php?number=1464

  Rectal prolapse is defined as a protrusion of the rectum beyond the anus. […] The theory of rectal intussusception is that the rectal mucosa, 6-8 cm from the anal verge, becomes the leading point, and intussusception is developed. Intussusception is aggravated by excessive straining for a long time and becomes an apparent rectal prolapse. […] The theory of perineal nerve injury suggests that the cause of rectal prolapse was a weakening of the pelvic floor muscles due to injury of the perineal nerve. […] The surgical procedures for rectal prolapse are diverse, indicating that the precise etiology and treatment strategy have not been clearly established.

• #8 Challenges in the Surgical Treatment of Rectal Prolapse | IntechOpen

  https://www.intechopen.com/chapters/62112

  The complete prolapse of the rectum is a true intussusception of the viscus outside of the anus, through the sphincters. […] Some anatomical abnormalities represent predisposing factors of rectal prolapse and many other are a consequence of the prolapse itself. […] The attempts to explain the etiology of rectal prolapse generated several different theories, all looking at one or more of the observed anatomical defects as the main abnormalities predisposing to rectal prolapse and thus proposing a specific surgical treatment. […] Instead, the cineradiographic studies of Broden and Snelleman identified the cause of rectal prolapse in a complete recto-rectal intussusception. […] All these mentioned conditions may complicate and worsen the clinical picture of a complete rectal prolapse and must be taken into consideration, in planning surgical treatment.

• #9 Rectal prolapse pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Rectal_prolapse_pathophysiology

  Rectal prolapse starts from rectal intussusception, followed by external mucosal prolapse, and eventually a full protrusion of all layers of the rectum. Rectal prolapse is associated with several coexisting anatomic abnormalities including diastasis of the levator ani, abnormally deep cul-de-sac and redundant sigmoid colon. […] The evolution of rectal prolapse starts from excessive straining over time that leads to the weakness of pelvic floor muscles and connective tissue injury (including nerve injury and neuropathy of the pelvic floor). These lead to rectal intussusception initially, followed by external mucosal prolapse, and eventually a full protrusion of all layers of the rectal wall through the anus. […] The shearing forces exerted by the passage of flatus or fecal matter push and pull the obstructing mucosal folds, thereby gradually involving and progressively traumatizing the deeper layers of the rectal wall and initiating a vicious circle of obstruction and prolapse formation.

• #10 Surgical Techniques for Rectal Prolapse

  https://www.mdpi.com/2036-7422/12/3/28

  Complete rectal prolapse or rectal procidentia is defined as a full-thickness protrusion of the rectum through the anal canal, and should be distinguished from the mucosal prolapse. […] Although the definite etiology of this disease is unclear, the most common related pathologies are the redundant sigmoid colon, a deep cul-de-sac, and the diastasis of levator ani muscles. […] Patients usually complain of fecal incontinence, which is thought to be a result of a chronic stretch of the anal sphincter and continuous stimulation of the rectoanal inhibitory reflex by the prolapsed tissue. […] Described surgical techniques are varied, and whether the approach is abdominal or perineal, the treatment aims to correct anatomical and functional abnormalities by the fixation of the rectum to the sacrum and/or the resection of the redundant bowel. […] In this article, these different techniques are reviewed for their surgical and functional outcomes and explained in the technical notes section with figures based on our cases.

• #11 Pediatric Rectal Prolapse: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/931455-overview

  Rectal prolapse refers to the circumferential extrusion of some or the entire rectal wall through the external anal sphincter. […] In children, rectal prolapse should always be considered a presenting sign of an underlying condition, and not a disease entity unto itself. Rectal prolapse starts as a mucosal extrusion from the mucocutaneous junction, which may eventually progress to full-thickness prolapse. […] Loss of the normal sacral curvature that causes a vertical tube between the rectum and the anal canal has been described as a causative factor. Straining during defecation predisposes children with constipation, diarrhea, or parasitosis to prolapse, as does childhood laxative usage. […] Children are predisposed to rectal prolapse due to anatomic considerations: A pelvic floor defect with levator ani muscle diastasis and a deep endopelvic fascia represent the pathophysiology of the disease. Patients with rectal prolapse have lost the normal semi-horizontal rectal position they also have weak muscle insertions to the pelvic walls and sacrum, an abnormally deep Douglas pouch and Houstons valves absence in approximately 75% of infants younger than 1 year of age.

• #12 Rectal Prolapse Treatment Guidelines – Paul E. Savoca

  https://www.paulsavocamd.com/conditions/rectal-prolapse-treatment-guidelines/

  Rectal prolapse, internal intussusception, and solitary rectal ulcer syndrome comprise a spectrum of anatomical abnormalities involving descent of full- or partial-thickness rectal wall associated with pelvic floor dysfunction. […] In patients with rectal prolapse, diastasis of the levator ani, an abnormally deep cul-de-sac, a redundant sigmoid colon, a patulous anal sphincter, and loss of the rectal sacral attachments are commonly found. […] Incontinence in the setting of rectal prolapse may be explained by the presence of a direct conduit (the prolapse) bypassing the sphincter mechanism, the chronic stretch and trauma to the sphincter caused by the prolapse itself, and continuous stimulation of the rectoanal inhibitory reflex by the prolapsing tissue. […] Chronic dilation of the anal sphincter with diminished internal anal sphincter pressures is a common finding and can lead to fecal incontinence.

• #13 Challenges in the Surgical Treatment of Rectal Prolapse | IntechOpen

  https://www.intechopen.com/chapters/62112

  The anatomical defect causing complete prolapse of the rectum is represented by a true recto-rectal intussusception. […] This anatomical abnormality together with the pelvic floor deficiency, the genital descent and urinary disturbances, all represent a consequence of the continuous straining of the rectum. […] The strong believe in a specific anatomical defect of pelvic floor as the main responsible of the rectal prolapse, represented the milestone suggesting the development of targeted operations, each focused on that anatomical abnormality. […] In addition, we should take into account that the various anatomical defects accompanying (not causing!) rectal prolapse need to be treated anyway, possibly at the same time; last but not least, we must pay attention to all the associated symptoms (fecal incontinence, constipation, urinary incontinence, sexual disturbances), planning treatment and adequate follow-up in an holistic approach.

• #14 RECTAL PROLAPSE | PPT

  https://www.slideshare.net/slideshow/rectal-prolapse-56836913/56836913

  Prolapse of the mucous membrane or the entire rectum outside the anal verge. This condition is common in children and elderly patients. […] Aetiology Decreased sacral curvature and decreased anal canal tone are the probable causes in infants. Diarrhea, cough, malnutrition are the additional factors in children. It may be due to reduced ischiorectal fossa fat, neurological causes, fibrocystic disease of pancreas or poorly developed pelvis. In adults, it is common in females, common in multipararepeated birth injuries to perineum results in damage to the perineal nerve supply. It is due to weakening of supporting tissue and levator ani muscle, atony of the sphincter, increased intraabdominal pressure due to any cause like chronic cough, stricture urethra. […] Complete Prolapse Also called as procidentia, is less common than partial prolapse It is common in females (6 : 1 :: female : male). It is due to weakened levator ani and supporting pelvic tissues. The descent is always more than 3.75 cm, contains all layers of the rectum (i.e. including muscular layer). Often descends down up to 10-15 cm. It is often associated with the uterine descent (uterine prolapse). It is also thought to be as an intussusception of the rectum.

• #15 Pediatric Rectal Prolapse: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/931455-overview

  The normal resting tone of the anal sphincter decreases in response to rectal distention. […] Most recently, information has suggested that rectal prolapse can be developed as a result of circumferential intussusception of the upper rectum and rectosigmoid colon. […] Rectal prolapse has been associated with a myriad of conditions, including increased intraabdominal pressure due to straining (as often occurs in toilet training and constipation), parasitic disease (the most common cause of rectal prolapse in developing countries), neoplastic disease, malnutrition (loss of ischiorectal fat pad), ulcerative colitis, Ehlers-Danlos syndrome, and others. […] Most cases of childhood rectal prolapse occur in children younger than 4 years, with the highest incidence during the first year of life. Anatomic considerations related to this early presentation include the vertical course of the rectum along the straight surface of the sacrum, a relatively low position of the rectum in relation to other pelvic organs, increased mobility of the sigmoid colon, relative lack of support by the levator ani muscle, loose attachment of the rectal mucosa to the underlying muscularis, and absence of Houston valves, seen in about 75% of infants.

• #16 An experimental study on the pathophysiology of rectal prolapse – Turkish Journal of Surgery

  https://turkjsurg.com/articles/an-experimental-study-on-the-pathophysiology-of-rectal-prolapse/doi/turkjsurg.2021.5188

  For decades, rectal prolapse has been hypothesized to be caused due to laxity or weakness of the pelvic floor muscles which is often supposed to be related to childbearing in females. […] The aim of this study was to evaluate the role of rectal redundancy in rectal prolapse pathophysiology. […] This study showed the role of rectal redundancy on the rectal prolapse pathophysiology. […] We believe that the pelvic floor weakness may not be fully responsible of rectal prolapse, but an anatomic variation of a redundant rectum in some individuals may predispose for rectal prolapse.

• #17 Update on the pathophysiology of rectal prolapse

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6924595/

  For decades, rectal prolapse has been hypothesized to be caused due to laxity or weakness of the pelvic floor muscles. […] We hypothesize that straining causes an increase in the intra-abdominal pressure, leading to inversion of the rectal wall at the level of the pelvic peritoneal reflection (cul-de-sac, i.e., rectovesical pouch in males or rectouterine pouch in females), which eventually presents clinically as rectal prolapse. […] We hypothesize that straining causes increased intra-peritoneal pressure, which caudally pushes the peritoneal reflection along with the anterior wall of the rectum. […] Therefore, we believe that the etiology underlying rectal prolapse depends on the rectal anatomy rather than on an intrinsic dysfunction of the pelvic floor muscles. […] The anatomical variations of a redundant rectum or hypermobility of the rectal wall may predispose to rectal prolapse in certain individuals. […] We believe that this simulation clearly demonstrates the process of rectal prolapse and supports our hypothesis.

• #18 Rectal Prolapse | SpringerLink

  https://link.springer.com/10.1007/978-3-030-30192-7_74

  Rectal prolapse is a protrusion of a portion of the rectum. The underlying pathogenetic mechanism is a concentric intussusception of the rectosigmoid junction secondary to weakness of the surrounding structures and exacerbated by straining. […] A long history of constipation and straining is usually elicited, and, in women, it often coexists with associated pelvic floor abnormalities. […] While usually self-reducing upon assumption of recumbent position, irreducible rectal prolapse is potentially life-threatening.

• #19 Pathogenesis – GPnotebook

  https://gpnotebook.com/pages/gastroenterology/rectal-prolapse/pathogenesis

  A rectal prolapse is in effect a hernia of the rectum through the floor of the pelvis. The mucosa and muscle wall of the rectum intussuscept through the anal canal. Contributory factors include denervation of the puborectalis muscle, loss of the acute anorectal angle, and poor fixation of the rectum to the sacrum. […] As the condition worsens, rectal prolapse may occur with only slight increases in intra-abdominal pressure, e.g. when the patient stands up.

• #20 Rectal prolapse: Causes, symptoms, and treatments

  https://www.medicalnewstoday.com/articles/319977

  Rectal prolapse happens when the rectum becomes unattached inside the body and comes out through the anus, effectively turning itself inside out. This condition is typically due to a weakening of the muscles that support the rectum. […] Rectal prolapse has multiple associated risk factors and causes, although doctors do not fully understand why some people get it. […] It often involves a weakening of the muscles that support the rectum and has various possible triggers, including: pregnancy, constipation or chronic straining, diarrhea, which affects about 15% of people, conditions that affect the pelvis or lower gastrointestinal tract. […] In the case of older females, rectal prolapse will often occur at the same time as a prolapsed bladder or gynecologic organ. This combined prolapse may occur due to general weakness in the pelvic floor muscles.

• #21 Rectal Prolapse – Clinical Features – Management – TeachMeSurgery

  https://teachmesurgery.com/general/anorectal/rectal-prolapse/

  The current theories surrounding full prolapse suggest that is a form of sliding hernia, through a defect of the fascia of the pelvic region. This may be caused by chronic straining secondary to constipation, a chronic cough, or from multiple vaginal deliveries. […] In contrast, partial thickness prolapses are associated with the loosening and stretching of the connective tissue that attaches the rectal mucosa to the remainder of the rectal wall. This often occurs in conjunction with long standing haemorrhoidal disease.

• #22 Rectal Prolapse and Rectal Stricture

  https://nadis.org.uk/disease-a-z/pigs/rectal-prolapse-and-rectal-stricture/

  Compared to other farm species, the pig appears to be particularly vulnerable to prolapse of the rectal tissue through the anus, which can be seen in any age group from as early as 1-2 days old up to adults. […] The fundamental cause of the prolapse is an increase in abdominal pressure, forcing a breakdown in the weak muscular support mechanism of the pelvis, which normally retains the rectum in place. […] There may well be both breed and gender differences in the vulnerability of individuals to prolapse occurring. […] Coughing. The process of coughing causes an increase in abdominal pressure and, in some cases, this may be sufficient to push out the rectum. […] Fast growth. Prolapsing can often be a problem in fast growing pigs, particularly from 30-60kg on very high-density diets.

• #23 Rectal Prolapse: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/14615-rectal-prolapse

  Rectal prolapse occurs when your rectum, part of your large intestine, slips down inside your anus. Its caused by a weakening of the muscles that hold it in place. […] Prolapse is the term healthcare providers use to describe any body part that has fallen from its normal position in your body. It usually means that the muscles supporting the part have weakened or deteriorated. […] Failure of the muscles that hold the rectum in place leads to rectal prolapse. Many things may contribute to this. Some possibilities include: Aging, Pregnancy and childbirth, Previous injury or surgery to your pelvis, Chronic constipation or diarrhea, Intestinal parasite infections, Chronic coughing or sneezing, Spinal cord or nerve damage, Cystic fibrosis. […] Not in adults. If rectal prolapse occurs in your child, it might go away after you treat the cause. […] If abdominal surgery isnt an ideal option for you, your surgeon may approach your rectal prolapse through your anus. […] Rectopexy has a 97% long-term success rate in fixing rectal prolapse. […] Rectal prolapse is usually the result of a long, gradual process of muscle deterioration.

• #24 Anemia grave por prolapso rectal

  http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082010001200007

  Rectal prolapse affects patients in both extremes of life, and women represent between 80 and 90 % of total cases. It consists of a total intussusception of the rectum and it is called complete when all layers of the rectal wall protrude outside the anus. The exact pathophysiology of this entity is unknown, but weakness of the pelvic floor and mobile rectum are usually present. Conditions that may be involved in the pathogenesis of rectal prolapse are constipation, obstetric traumas, hysterectomy, previous anorectal surgery, spina bifida and operations or traumas to the spine. […] The prolapse may occur as an isolated process or together with other pelvic floor problems, such as rectocele, enterocele, cystocele and uterine or vaginal prolapse. […] The diagnosis is made on physical examination. Other diagnostic tests, like defaecograhy, anal endosonography or anal manometry, have limited utility for patient management, but are useful in studying the pathophysiology of the disorder.

• #25 Rectal prolapse | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/rectal-prolapse

  We do not know the exact cause of rectal prolapse, but risk factors include chronic constipation, straining to pass bowel motions, and weakened pelvic floor muscles. […] The exact cause of rectal prolapse is unknown, but risk factors include: chronic constipation, straining to pass bowel motions, weakened pelvic floor muscles, weakened anal sphincter muscles, weakening of the muscles associated with ageing, since rectal prolapse is more common in people aged 65 years and over, genetic susceptibility, since it appears that some people with rectal prolapse have a blood relative with the same condition, parasitic infection, such as schistosomiasis very rare in Australia, any condition that chronically increases pressure within the abdomen, such as benign prostatic hypertrophy, or chronic obstructive pulmonary disease (COPD), structural problems with the ligaments that tether the rectum to its surrounds, congenital problems of the bowel, such as Hirschsprungs disease or neuronal intestinal dysplasia, prior trauma to the lower back, disc disease in the lower back.

• #26 Rectal prolapse in the pediatric population—a narrative review of medical and surgical management – Kodia – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/8810/html

  The physical straining associated with constipation secondary to increased abdominal pressure can contribute to rectal prolapse. […] Neurologic conditions related to rectal prolapse include myelomeningocele, tethered cord, neurogenic bladder, spinal cord injury and spina bifida. […] Behavioral disorders have been associated with increased rectal prolapse incidence. […] Finally, it is critical all pediatric healthcare providers consider anal penetration as a causative factor associated with pediatric rectal prolapse; sexual abuse and nonaccidental trauma should be considered and ruled out in the management of children presenting with rectal prolapse.

• #26 Rectal prolapse in the pediatric population—a narrative review of medical and surgical management – Kodia – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/8810/html

  Numerous conditions contribute to rectal prolapse in children, including constipation, gastrointestinal infectious and non-infectious etiologies, cystic fibrosis, malnutrition, neurogenic, anatomic, lead points, and abuse. […] The condition is divided into two subtypes with a further breakdown of the second subtype. Type I is considered a false rectal prolapse, otherwise considered to be mucosal extrusion through the external anal sphincter without full thickness prolapse. This presentation can be distinguished by radial folds of the rectal mucosa, usually less than 2 cm. Type II refers to a true rectal prolapse with a full-thickness prolapse of the rectal wall. […] Various conditions contribute to rectal prolapse and including constipation, gastrointestinal infectious and non-infectious etiologies, cystic fibrosis (CF), malnutrition, neurogenic and anatomic factors and lead points, and abuse.

• #27 Blog | Rectal Prolapse

  https://www.doctoryogeshwari.com/blog1.html

  Rectal prolapse is a condition in which the rectum (the last part of the large intestine before it exits the anus) loses its normal attachments inside the body, allowing it to telescope out through the anus, thereby turning it inside out. […] Various factors, such as age, long-term constipation and the stress of childbirth may cause these ligaments and muscles to weaken which means that the rectum’s attachment to the body also weakens. This causes the rectum to prolapse. […] The exact cause of this weakening is unknown; however, rectal prolapse is usually associated with the following conditions: Advanced age, Chronic constipation, Chronic diarrhea, Long-term straining during defecation, Pregnancy and the stresses of childbirth, Previous surgery, Cystic fibrosis, Whooping cough, Multiple sclerosis, Paralysis (Paraplegia), Weakened pelvic floor muscles, Weakened anal sphincter muscles, Genetic susceptibility, since it appears that some people with rectal prolapse have a blood relative with the same condition, Parasitic infection, such as schistosomiasis. […] Rectal prolapse and internal rectal intussusception has been classified according to the size of the prolapsed section of rectum, a function of rectal mobility from the sacrum and infolding of the rectum. This classification also takes into account sphincter relaxation.

• #28 Rectal Prolapse Treatment Guidelines – Paul E. Savoca

  https://www.paulsavocamd.com/conditions/rectal-prolapse-treatment-guidelines/

  Decreased anal squeeze or resting pressures may predate the actual development of the prolapse and contribute to the development of the condition. […] The fixation of the rectum in the pelvis with suture, first described by Cutait in 1959, aims to correct the telescoping of the redundant bowel and causes fixation of the rectum from the resultant scarring and fibrosis. […] The precise etiology of constipation is unclear. Mechanical as well as functional reasons for constipation should be considered. […] Independent of the technique used to perform the rectopexy, the division of the lateral stalks during the rectal dissection has been associated with worsening constipation. […] It was theorized that the denervation of the rectum from the neural efferents thought to reside in the lateral ligaments was the cause of this complication.

• #29 Rectal prolapse – Wikipedia

  https://en.wikipedia.org/wiki/Rectal_prolapse

  The assumed mechanism of obstructed defecation is by disruption to the rectum and anal canal’s ability to contract and fully evacuate rectal contents. […] Some believe that internal rectal intussusception represents the initial form of a progressive spectrum of disorders the extreme of which is external rectal prolapse.

• #30 Challenges in the Surgical Treatment of Rectal Prolapse | IntechOpen

  https://www.intechopen.com/chapters/62112

  Since constipation, either in term of its persistency or de novo occurrence represents a major concern, leading to bad quality of life and probably being responsible for recurrence of prolapse, it is obviously attractive the idea of eliminating such problem with a safe resection such as a sigmoidectomy combined with rectopexy.

• #31 Rectal prolapse associated with anorexia nervosa: a case report and review of the literature | Journal of Eating Disorders | Full Text

  https://jeatdisord.biomedcentral.com/articles/10.1186/2050-2974-1-39

  It is thought that the descending bowel into the rectum may cause a mechanical blockage that is worsened with persistent straining, pelvic floor muscle incoordination and colonic dysmotility. […] The association with EDs and chronic constipation has been well-documented. […] Although the relation between chronic constipation and AN has been documented previously, its underlying etiology is not yet clearly understood. […] Delayed solid gastric emptying witnessed in AN may worsen chronic constipation and its associated symptoms. […] In the case of our patient, a number of indirect risk factors likely predisposed her to developing the prolapse as opposed to any one obvious cause.

• #32

  https://omim.org/entry/176780

  Connell et al. (2008) found that the uterosacral ligaments of 18 women with pelvic organ prolapse showed approximately 75-fold and 17-fold lower expression of HOXA11 (142958) and collagen III (COL3A1; 120180), respectively, compared to controls. […] In addition, MMP2 (120360) was increased 2-fold in patient tissue. Histologic examination showed more loosely organized collagen architecture in the ligaments from patients with prolapse. […] The findings were consistent with a pathway of extracellular matrix metabolism involving HOX11A, COL3A1, and MMP2. Connell et al. (2008) concluded that HOXA11 is essential for the development of the uterosacral ligaments, and suggested that women with pelvic organ prolapse may have weakened connective tissue due to changes in this signaling pathway.

• #33 Rectal Prolapse in Animals – Digestive System – Merck Veterinary Manual

  https://www.merckvetmanual.com/digestive-system/diseases-of-the-rectum-and-anus/rectal-prolapse-in-animals

  Rectal prolapse occurs in a wide range of species and may be caused by enteritis, intestinal parasites, rectal disorders and other underlying conditions. […] In rectal prolapse, one or more layers of the rectum protrude through the anus due to persistent tenesmus associated with intestinal, anorectal, or urogenital disease. Prolapse may be classified as incomplete, in which only the rectal mucosa is everted, or complete, in which all rectal layers are protruded. […] Rectal prolapse is common in young animals in association with severe diarrhea and tenesmus. […] Perineal hernia or other interruption of normal innervation of the external anal sphincter may also lead to rectal prolapse. […] Rectal prolapse is probably the most common GI problem in pigs due to diarrhea or weakness of the rectal support tissue within the pelvis.

• #34 Strangle rectal prolapse: Emergency perineal rectosigmoidectomy | Cirugía Española (English Edition)

  https://www.elsevier.es/en-revista-cirugia-espanola-english-edition–436-articulo-strangle-rectal-prolapse-emergency-perineal-S2173507721000193

  Rectal prolapse is defined as a full-thickness protrusion of the rectal wall through the anal canal. It commonly occurs in elderly women due to weakness of the pelvic floor muscles, and it is uncommon in young men. […] There is still debate about the pathophysiological mechanism of rectal prolapse, but chronic abdominal strain is present in most cases. The most common form is the chronic course of the disorder, which is studied with diagnostic tests that include sigmoidoscopy, videodefecography, endoanal ultrasound, and anal manometry. In the context of incarceration, diagnostic tests are omitted since urgent surgical treatment is required. […] Surgical treatment seeks to correct the anatomy of the prolapse, restore continence, and improve constipation and evacuation. Classically, 2 approaches are described (perineal and abdominal) for fixation, intestinal resection, or plication. The choice of technique is made based on the clinical and functional characteristics of the patient.

• #35

  http://www.veterinaryhandbook.com.au/Diseases.aspx?diseasenameid=226

  Rectal prolapse may be predisposed by conditions that increase intrapelvic pressure or abdominal straining, such as persistent riding behaviour, coughing, coccidiosis, and chronic diarrhoea. […] Any partial, intermittent prolapse may lead to rectal mucosal injury and irritation, more straining, and eventually complete prolapse. […] Once prolapsed, the blood supply becomes compromised and affected tissue will swell, become congested, oedematous and eventually necrotic. […] Without intervention there is a risk of peritonitis and death. […] Prevention and treatment of predisposing underlying diseases and conditions such as pneumonia, riding behaviour or urinary obstruction are required to prevent rectal prolapse.

• #36 Rectal Prolapse, Rectal Intussusception, Rectocele, Solitary Rectal Ulcer Syndrome, and Enterocele | Abdominal Key

  https://abdominalkey.com/rectal-prolapse-rectal-intussusception-rectocele-solitary-rectal-ulcer-syndrome-and-enterocele/

  Rectal prolapse, intussusception (occult rectal prolapse), solitary rectal ulcer syndrome (SRUS), and rectocele are common pelvic floor disorders that share many clinical features and have a common pathogenesis. Chronic constipation, especially an evacuation disorder, is often an underlying problem that leads to these abnormalities. For example, chronic straining may cause intussusception of the rectal mucosa, which subsequently can develop into a full-thickness rectal prolapse. A prolapse may cause excessive stretching of the rectal mucosa that can lead to mucosal injury and cause a rectal ulcer. Furthermore, chronic straining and difficulty with evacuation may induce a rectocele. Because these problems are interrelated, an integrated multidisciplinary approach is required for their management.

• #37 Solitary rectal ulcer syndrome – UpToDate

  https://www.uptodate.com/contents/solitary-rectal-ulcer-syndrome

  The pathogenesis of the solitary rectal ulcer is incompletely understood. However, a number of factors appear to have a causative role in individual reports. It is possible that different etiologies may contribute to the development of solitary rectal ulcer syndrome. […] A common observation in a number of reports is rectal prolapse or rectal intussusception and paradoxical contraction of the puborectalis muscle. A case-control study compared anorectal physiology and defecation proctography in 25 patients with solitary rectal ulcer syndrome with matched controls with either outlet obstruction (25 patients), overt rectal prolapse without any mucosal change (25 patients), or overt rectal prolapse with mucosal changes (14 patients). Patients with solitary rectal ulcer syndrome more frequently had increasing anal pressure at straining, paradoxical puborectalis contraction, and prolapse of the inner circular smooth muscle of the rectum and less frequently had complete rectal emptying compared with controls. Compared with patients with overt rectal prolapse, mean resting and squeezing anal pressures were significantly higher. […] Rectal prolapse and paradoxical contraction of the puborectalis muscle can result in rectal trauma by two different mechanisms.

• #38 Rectal Prolapse and Rectal Stricture

  https://nadis.org.uk/disease-a-z/pigs/rectal-prolapse-and-rectal-stricture/

  Variable temperatures. Pigs have a poor ability to control their body temperature and tend to be adversely affected by variation in the ambient temperature and prone to chilling. […] Rectal stricture is a common condition in growing pigs in which scar tissue forms a ring inside the terminal rectum which slowly closes, obstructing the bowel and preventing defecation. […] If the stricture starts adjacent to the anus it is reasonable to assume that a prolapse previously bitten off by another pig was the start point of the stricture. […] However, in many cases there is a section of normal mucosa between the anus and the stricture, suggesting that a prolapse had not been the root cause. […] Where strictures occur not associated with prolapses, it is essential to establish the primary cause and address that to prevent further causes.

• #39 A Rare, Severe Complication of Delayed Surgical Treatment for Rectal Prolapse

  https://clinmedjournals.org/articles/cmrcr/clinical-medical-reviews-and-case-reports-cmrcr-11-446.php?jid=cmrcr

  Transanal small bowel evisceration is a very rare presentation. However, it is associated with significant morbidity and mortality. […] This surgical emergency is very rare but is thought to be due to a defect in the colon or rectal wall allowing the small bowel to herniate and prolapse through the anal opening. […] The exact pathophysiologic mechanism is not fully understood. However, it is thought to be caused by chronic rectal prolapse that forms a hernia sac in the pouch of Douglas. This hernia sac applies pressure to the anterior wall of the rectum at the antimesenteric border. The repeated pressure to the wall results in ischemia and weakening of the wall. It is proposed that increased intraabdominal pressure from straining, vomiting, coughing, or weightlifting, can be the precipitating event that leads to perforation of the weakened wall, allowing small bowel to herniate through the defect and eviscerate through the anus. […] More than 75 percent of these cases were due to chronic rectal prolapse and a sudden increase in intra-abdominal pressure.

• #40 An Age-Old Problem: The Surgical Treatment of Complete Rectal Prolapse

  https://www.mdpi.com/2036-7422/12/3/32

  Complete rectal prolapse (CRP) is defined as a circumferential, full-thickness intussusception of all layers of the rectal wall beyond the anal verge. […] Several etiopathogenetic theories have been described to date, including pelvic floor weakness, Douglas redundant sigmoid colon, pudendal nerve neuropathy, diastasis of the levator ani, or excessive rectal mobility, due to loose attachments to the sacrum. […] The initial pathophysiology theory, in which CRP would arise from rectal intussusception, has been contradicted by more recent works.

• #41 Challenges in the Surgical Treatment of Rectal Prolapse | IntechOpen

  https://www.intechopen.com/chapters/62112

  The ideal surgical treatment for correction of the rectal prolapse should be mini-invasive, with low morbidity, almost nihil mortality and a reasonable percentage of recurrence. […] The history of the surgical treatment of rectal prolapse is rich of several, different surgical techniques, all proposed with the aim of eliminating the anatomical defect which was believed to be the main responsible for the prolapse. […] In first place, the prolapsed rectum is excised, the deep peritoneal pouch is shortened and closed and finally, pelvic floor muscles can be repaired. […] In fact, full mobilization of the rectum and fixation to the sacrum leaving lateral ligaments, thus preserving rectal innervation, guarantees from further intussusception. […] There are strong evidences that this operation may be a very good choice for a young, fit patient.

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