الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Complete rectal prolapse is the transposition of the entire rectal wall into the rectal lumen, the anal canal or beyond the anal canal. Patients usually suffer from protrusion of a moist mass, soiling, fecal incontinence, bloody diarrhea and pelvic pain. Irreducibility, strangulation, ulceration and gangrene of the prolapse may occur.
Complete rectal prolapse is accompanied with many anatomical changes like diastasis of levator ani muscles and weakened pelvic fascia with loose attachments of the rectum to the sacrum and pelvic wall.
Rectal prolapse is an intussusception of the rectum and may be categorized as occult (internal), mucosal or complete (external). Internal or occult rectal prolapse does not extend beyond the anal canal; some clinicians believe that this is a precursor of complete prolapse, when the intussusception extends beyond the anus it results in complete prolapse.
The condition may be associated with functional problems such as constipation and incontinence and anatomic defects such as rectoceles, enteroceles, cystoceles and uterine or vaginal prolapse.
A degree of fecal incontinence is found in 28% to 88% of patients with rectal prolapse. Patients with rectal prolapse are at risk for incontinence because of underlying neurologic or muscular disorders. The prolapsing rectum may itself cause fecal incontinence by chronically dilating and stretching the sphincters together with chronic stimulation of the recto-anal inhibitory reflex.
Pudendal neuropathy may develop as a consequence of repetitive straining in attempting evacuation. With increasing pelvic floor descent, the pudendal nerves may be stretched, resulting in a traction injury and delayed conduction along the nerve.
Constipation is associated with rectal prolapse in 15% to 65% of patients. Straining may force the anterior rectal wall of the upper rectum into the anal canal, causing a solitary rectal ulcer due to mucosal injury at this point. Rectoceles are occasionally implicated in constipation and may contribute to the development of rectal prolapse.
Symptoms depend on the type and degree of prolapse. Soiling and mucous discharge with blood staining may be present. Pelvic outlet obstruction and constipation together with a feeling of incomplete evacuation are the most common symptoms. Pudendal neuropathy may ensue after years of straining. Mucous discharge may occur as chronically inflamed mucosa produces excess mucous that a compromised sphincter can’t control.
Generally, repairs of prolapse are categorized into abdominal and perineal approaches, with the former being traditionally perceived as more morbid but more enduring, and the latter as less invasive but more prone to recurrence .