Our Summary

The research paper is about bowel incontinence (losing control over bowel movements) in women, and how it might be linked to a condition called internal rectal prolapse (when the rectum, the last part of the large intestine, starts to drop down). The researchers studied women who were experiencing moderate to severe bowel incontinence without any other complications like muscle defects in the anus.

Of the 2082 women in the database, 174 fitted the criteria for the study. Almost half of these women were found to have high-grade internal rectal prolapse, which was mostly associated with sudden and intense bowel incontinence. Passive bowel incontinence, which is less severe, was more common in women with low-grade rectal prolapse. The researchers also noticed that the resting pressure in the anus was lower in older patients and in those with high-grade prolapse.

Interestingly, the severity of the prolapse was not directly linked with the severity of bowel incontinence. The study concludes that high-grade internal rectal prolapse is quite common in women with severe bowel incontinence, even when there are no defects in the anal sphincter (ring of muscle controlling the exit of the bowels). Therefore, they suggest that doctors should routinely conduct a specific type of X-ray examination called defecation proctography in cases of bowel incontinence.

FAQs

  1. What is the role of internal rectal prolapse in the aetiology of faecal incontinence?
  2. What was the incidence of internal rectal prolapse in patients with faecal incontinence without an anal sphincter defect?
  3. Should defecation proctography be routine in the work up of faecal incontinence?

Doctor’s Tip

A doctor may tell a patient undergoing rectal prolapse surgery to expect some discomfort and pain following the procedure. They may recommend taking pain medication as prescribed, and to avoid strenuous activities or heavy lifting for a period of time. It is important to follow post-operative care instructions provided by the surgeon to ensure proper healing and minimize the risk of complications. Additionally, the doctor may advise the patient to eat a high-fiber diet and stay hydrated to promote regular bowel movements and prevent straining. Regular follow-up appointments will be necessary to monitor recovery and address any concerns.

Suitable For

Patients who are typically recommended rectal prolapse surgery are those who have high-grade internal rectal prolapse and are suffering from urge faecal incontinence, without anal sphincter lesions. These patients may have moderate to severe pure faecal incontinence and may not have obstructed defecation. Defecation proctography is an important diagnostic tool in identifying internal rectal prolapse and should be routine in the workup of faecal incontinence in these patients.

Timeline

Before rectal prolapse surgery, a patient may experience symptoms of faecal incontinence, including urge and passive faecal incontinence. They may undergo tests such as defecation proctography and anorectal physiology to assess the severity of their condition. These tests may show the presence of high-grade internal rectal prolapse, which is associated with urge faecal incontinence.

After rectal prolapse surgery, the patient may experience relief from their faecal incontinence symptoms. The surgery aims to correct the prolapse and improve the function of the rectum and anus. Recovery from the surgery may involve a period of rest and recovery, followed by physical therapy to strengthen the pelvic floor muscles. The patient may also be advised to make lifestyle changes, such as dietary modifications, to help prevent further episodes of faecal incontinence. Follow-up appointments with the surgeon may be scheduled to monitor the patient’s progress and address any concerns.

What to Ask Your Doctor

  1. What is the success rate of rectal prolapse surgery for patients with faecal incontinence?
  2. What are the potential risks and complications associated with rectal prolapse surgery?
  3. How long is the recovery period after rectal prolapse surgery?
  4. Will I need to make any lifestyle changes or follow a specific diet after the surgery?
  5. Are there any alternative treatment options for rectal prolapse that I should consider?
  6. How will the surgery impact my bowel function and continence after the procedure?
  7. Will I need to undergo any additional tests or procedures before the surgery?
  8. How experienced is the surgical team in performing rectal prolapse surgery?
  9. What is the long-term outlook for patients who undergo rectal prolapse surgery?
  10. Are there any specific instructions or precautions I should follow before and after the surgery to ensure optimal outcomes?

Reference

Authors: Bloemendaal AL, Buchs NC, Prapasrivorakul S, Cunningham C, Jones OM, Hompes R, Lindsey I. Journal: Int J Surg. 2016 Jan;25:118-22. doi: 10.1016/j.ijsu.2015.12.004. Epub 2015 Dec 14. PMID: 26700198