WHAT IS IT?
Rectal intussusception is known by a number of other terms including internal or occult rectal prolapse. It refers to when the rectum telescopes down either within the rectum (low grade internal prolapse) or down into the anal canal (high grade internal prolapse). When the rectum protrudes through the anal canal, this is described as an overt or ‘external rectal prolapse and is different from intussusception.
WHAT ARE THE CAUSES?
Rectal intussusception is often caused by damage to the pelvic floor from childbirth, and is thus much more common in women (90% of patients). However in both men and women it may be caused by an underlying tendency to pelvic floor weakness. Rectal intussusception often co-exists with other pelvic floor abnormalities including rectocoele and enterocoele.
WHAT ARE THE SYMPTOMS?
The common symptoms are of obstructed defaecation syndrome. Most strikingly, patients often get the sensation of a blockage which is made worse by straining. Some patients get pelvic pain. Others may also suffer with a degree of incontinence.
WHAT IS IT DIAGNOSED?
We often suspect the diagnosis on the basis of symptoms and examination in clinic. You may need several tests but a proctogram is the one that usually confirms the diagnosis.
WHAT IS IT TREATED?
About one third of patients will get significant or complete resolution of their symptoms with simple measures like dietary changes or pelvic floor retraining. In other patients, we may suggest laparoscopic ventral rectopexy, which lifts the rectum out of the pelvis and restores it to its normal position. As intussusception rarely occurs in isolation, it may also be necessary to correct a rectocoele and/or enterocoele at the same time.
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