Impact of Rising Grades of Internal Rectal Intussusception on Fecal Continence and Symptoms of Constipation

Hawkins, Alexander T.; Olariu, Adriana; Savitt, Lieba; Gingipally, Shalini; Wakamatsu, May; Pulliam, Samantha J.; Weinstein, Milena M.; Bordeianou, Liliana

doi:10.1097/dcr.0000000000000510

Cited by 64 publications

(35 citation statements)

References 32 publications

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“…[53][54][55] A greater Oxford rectal prolapse grade 56 is associated with increased fecal incontinence severity. 57 The subgroup analysis indicated that anal canal hyposensitivity was associated with more severe incontinence scores in women.…”

Section: Discussionmentioning

confidence: 97%

“…While internal anal sphincter atrophy and degeneration is increasingly recognized to be of pathological importance, increased IAS thickness is observed in rectal intussusception and/or rectal prolapse, which can contribute to fecal incontinence 53‐55 . A greater Oxford rectal prolapse grade 56 is associated with increased fecal incontinence severity 57 …”

Section: Discussionmentioning

confidence: 99%

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The relationships between the results of contemporary tests of anorectal structure and sensorimotor function and the severity of fecal incontinence

Heitmann

Rabbitt

Schloithe

et al. 2020

Neurogastroenterology Motil

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Background: Diagnostic investigations for fecal incontinence (FI) assess the structure and sensorimotor function of the anorectum. Investigations include anorectal manometry, anorectal sensory testing, pudendal nerve terminal motor latencies (PNTML), and endoanal sonography. The severity of FI and results of investigations are often discordant and the rate of symptom resolution following treatment remains <40%. High-resolution anorectal manometry (HRAM) and three-dimensional endoanal ultrasound (3D-US) have been introduced during the last decade. This study aims to assess the strength of relationships between contemporary investigation results and FI severity. Methods: Adults presenting for investigation of FI were assessed using the St Mark's FI severity score (SMIS), HRAM, anorectal sensory testing, PNTML, and 3D-US.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

The relationships between the results of contemporary tests of anorectal structure and sensorimotor function and the severity of fecal incontinence

Heitmann

Rabbitt

Schloithe

et al. 2020

Neurogastroenterology Motil

View full text Add to dashboard Cite

show abstract

“…Dvorkin examined 896 proctograms and found anorectal pain and prolapse were predictive of intussusception on proctography but there were no symptoms which distinguished between obstructing and nonobstructing intussusception on proctography [7]. Intussusception has also been shown to play a role in faecal incontinence [8,9].…”

Section: Discussionmentioning

confidence: 99%

“…The mean or median scores in those patients with and without certain features obstructing and nonobstructing intussusception on proctography [7].Intussusception has also been shown to play a role in faecal incontinence [8,9].…”

Section: Ta B L Ementioning

confidence: 99%

“…Incomplete evacuation of barium rectal paste from a rectocele despite rectal emptying (trapping rectocele) does not necessarily translate to symptomatic incomplete evacuation [5,6]. Although intussusception on proctography is associated with toilet revisiting and slower evacuation there are no symptoms which can predict obstructing intussusception on proctography [7] and increasing grade on proctography is associated with increasing incontinence [8] but not constipation [9]. An enterocele which appears to compress the rectal wall does not necessarily impede evacuation [10].…”

Section: Introductionmentioning

confidence: 99%

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Is there any association between symptoms and findings on imaging in pelvic floor defaecatory dysfunction? A prospective study

et al. 2020

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Aim To compare features on imaging (integrated total pelvic floor ultrasound (transperineal, transvaginal) and defaecation proctography) with bowel, bladder and vaginal symptoms in pelvic floor defaecatory dysfunction. Method A prospective observational case series of 216 symptomatic women who underwent symptom severity scoring (bowel, bladder and vaginal), integrated total pelvic floor ultrasound and defaecation proctography. Anatomical (rectocele, intussusception, enterocele, cystocele) and functional (co‐ordination, evacuation) features were examined. Results Irrespective of imaging modality, patients with a rectocele had higher International Consultation on Incontinence Modular Questionnaire – Vaginal Symptoms (ICIQ‐VS) scores than patients without. On integrated total pelvic floor ultrasound, ICIQ‐VS quality of life scores were higher in those with a rectocele. There was a higher International Consultation on Incontinence Modular Questionnaire – Bowel Symptoms (ICIQ‐BS) bowel pattern score in those with a rectocele, and a lower ICIQ‐BS bowel pattern and sexual impact score in those with intussusception. Poor co‐ordination was associated with increased ICIQ‐BS bowel control scores and obstructed defaecation symptom scores. On defaecation proctography, ICIQ‐VS symptom scores were lower in patients with poor co‐ordination. Conclusion Patients with a rectocele on either imaging modality may have qualitative vaginal symptoms on assessment. In patients with bowel symptoms but no vaginal symptoms, it is not possible to predict which anatomical abnormalities will be present on imaging.

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Total pelvic floor ultrasound can reliably predict long‐term treatment outcomes for patients with pelvic floor defaecatory dysfunction

Hainsworth

Robles

Ferrari

et al. 2022

Neurourology and Urodynamics

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Aim Integrated total pelvic floor ultrasound (TPFUS) may provide an alternative to defaecation proctography (DP) in decision making and treatment planning for patients with pelvic floor defaecatory dysfunction (PFDD). This study evaluates the use of TPUS as a screening tool, and its likelihood to predict long‐term treatment outcomes. Methods Two blinded clinicians reviewed 100 women who had historically presented to a tertiary referral colorectal unit with PFDD from October 2014 to April 2015. The clinical history of the patients together with TPFUS or DP results were used to decide on main impression, treatment plan, likelihood of surgery and certainty of plan. These were compared to the actual treatment received six months later and again after a median follow‐up of 68 months (range 48–84). Results A total of 82 patients were treated with biofeedback only and 18 also underwent surgery. There were no complications in any of the patients who had surgery. When compared with the actual treatment received, 99 of the 100 of the TPFUS group would have been treated appropriately. The number of false positives for surgical treatment was lower with TPFUS compared to DP. Clinician confidence in the overall decision was significantly higher after review with DP. Conclusions TPFUS is a reliable assessment tool for PFDD. It can identify patients who can go straight to biofeedback and is just as good as DP at predicting likelihood of surgery. We might be able to rely on TPFUS more significantly in the future, even for surgical planning.

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Impact of Rising Grades of Internal Rectal Intussusception on Fecal Continence and Symptoms of Constipation

Abstract: Increasing grades of rectal intussusception are associated with increasing fecal incontinence but not constipation.

Cited by 64 publications

References 32 publications

The relationships between the results of contemporary tests of anorectal structure and sensorimotor function and the severity of fecal incontinence

The relationships between the results of contemporary tests of anorectal structure and sensorimotor function and the severity of fecal incontinence

Is there any association between symptoms and findings on imaging in pelvic floor defaecatory dysfunction? A prospective study

Total pelvic floor ultrasound can reliably predict long‐term treatment outcomes for patients with pelvic floor defaecatory dysfunction

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