Anorectal function and defecation dynamics in patients with rectal prolapse

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Summary

Seven female patients with clinical rectal prolapse and nine healthy female control subjects were studied with anorectal manometry, external sphincter electromyography, and a saline continence test. Resting anal tone, maximum voluntary squeeze, and rectal functional capacity were significantly decreased in the rectal prolapse patients (p<0.02). During defecation attempts, external sphincter or pelvic floor electromyographic activity decreased in all of the control subjects, whereas six prolapse patients showed increased electromyographic activity and one had no change in activity (p<0.01). Continence to saline solution was also significantly impaired in prolapse patients (p<0.001). Postoperative studies in three patients who underwent repair revealed persistence of abnormal anorectal function and defecation dynamics.

Patients with rectal prolapse have impaired resting and voluntary sphincter activity, decreased functional rectal capacity, and impaired continence. The failure of normal relaxation of the external sphincter or pelvic floor during defecation attempts, as demonstrated in the patients described herein, may contribute to the development of prolapse and denervation sphincter injury seen in such patients.

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Presented at the 28th Annual Meeting of the Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 12 and 13, 1987.

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From the Departments of Surgery and Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa.

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