Rectoanal Intussusception

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Rectoanal intussusception and SRUS have many common features. Dysfunction of the rectum with the development of abnormal defecatory patterns is usually the underlying pathogenesis. Chronic straining may induce intussusception of the rectal mucosa, which in turn may develop into full-thickness rectal prolapse. The occult intussusception may also predispose to a persistent feeling of incomplete evacuation with the chronic urge to strain. Straining may cause excessive tensile forces on the anterior wall of the rectum resulting in ulceration.

Rectoanal intussusception, also known as occult rectal prolapse or internal procidentia, is an intussusception of the rectal wall that does not protrude through the anus. It may be asymptomatic or associated with incontinence or constipation. Although it is strongly associated with mucosal prolapse, full-thickness rectal prolapse, and perineal descent, the finding of occult rectal prolapse is not necessarily pathologic. Diagnosis is made by defecography and is seen in up to 50% to 60% of the defegrams of asymptomatic healthy volunteers.4 In addition, the presence of intussusception does not correlate with rectal emptying,5 and it seldom leads to rectal prolapse.6 Care must be taken when associating symptoms with rectal intussusception because it is usually not a cause of symptoms but a marker for underlying rectal dysfunction in symptomatic individuals and is frequently found with other abnormalities of the pelvic floor.

For patients with internal intussusception and constipation from obstructive or dyssynergic defecation, the first line of therapy is conservative treatment aimed at restoring normal defecatory habits. Behavioral modifications include suppressing the urge to strain, minimizing toileting time, and decreasing the number of toilet visits. Additional behavioral modifications can be accomplished with biofeedback therapy, particularly in patients with obstructed defecation related to paradoxical, or nonrelax-ing puborectalis syndrome. Dietary modifications include a fiber-enriched diet, fiber supplementation, and eight glasses of noncaffeinated beverages per day, all of which promote regularity and restoration of normal rectal motil-ity. Laxatives and scheduled enemas may also be beneficial in rectal evacuation and suppressing the urge to strain.

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Constipation Prescription

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