الفهرس 
Applied ANATOMY OF THE RECTUM &ANAL CANALOnly 14 pages are availabe for public view
 |  | from | 258 |  |  |
| | | from | 258 | | |
Abstract
Summary & Conclusion
Pelvic floor pathology tends to be complex and crosses several disciplines. Functional rectal disorders are subdivided into rectal prolapse, obstructive defecation, rectocele and rectal intussusception.
The search for the optimal treatment of rectal prolapse is not a new problem. It is known that rectal prolapse is commonly encountered in older women but that it is also seen in children and young men. it is associated with both constipation and fecal incontinence however we define those terms. rectal prolapse has a spectrum of physiologic presentations and that the center for pelvic floor disorders evaluation is the key to understanding the profile of individual patients.
Continent patients have higher anal canal pressures than incontinent patients, but preoperative anal canal pressures are not reliable predictors of postoperative continence. Preoperative values may not be reliable predictors of continence. Defecography and colon transit studies may reveal information that is important for planning the surgical approach.
Three approaches are now available for the treatment of rectal prolapse, and each has its advantages and disadvantages. Procedures performed with an abdominal approach have a lower recurrence rate than with a perineal approach but are more invasive and often require a longer stay in the hospital.
The perineal approach is associated with a higher recurrence rate but places the patient under less stress. This approach is generally reserved for debilitated or elderly patients. The use of laparoscopic techniques may permit surgeons to perform procedures that were limited to the traditional abdominal approach, with much lower impact on the patient.
Because it is well tolerated, laparoscopy may extend the abdominal approach options to patients who were previously treated with a perineal approach. Regardless of technique, most patients experience resolution of their prolapse with no recurrence.
Traditional articles focus on the recurrence rate of rectal prolapse after repair. Although this is certainly important factor, perhaps there should be more emphasis on the functional outcome than on recurrence rates. Future efforts should focus on clarification of definitions, prospective recording of function, follow-up, and multicenter studies.
Our understanding and treatment of rectal prolapse has come a long way, but we are not at time journey’s end. There are still many questions that remain. Is rectal prolapse a single diagnosis or merely a manifestation of several underlying causes? Can prolapse be prevented once the pathophysiologic features are better understood? Can patient profiles suggest a best procedure for an individual patient. These questions warrant further research.
The specific goals of surgical management of full thickness rectal prolapse are to minimize the operative risk in typically elderly populations, eradicate the external prolapse of rectum, improve bowel function, and reduce the risk of recurrence. The growing body of literature supports the concept that laparoscopic surgical techniques can safely provide the benefits of low recurrence rates and improved functional outcome for patients with full thickness rectal prolapse.
Chronic constipation is a common self-reported bowel symptom that affects 2–30% of people in the western world. It has a considerable impact on health costs and quality of life. About 30–50% of constipated patients have obstructed defecation
Biofeedback is a technique that is frequently used as first-line therapy to manage obstruction defecation syndrome.
Biofeedback improved the defecation rate by changing the anorectal angles, improving rectal sensation, and diminishing the electromyographic voltage of the external anal sphincter. as surgical intervention has a little value, So patients in whom an adequate trial of dietary management and biofeedback fails can be considered for injection of botulinum toxin into the puborectalis muscle and external anal sphincter. Of patients treated this way, 75% improve, although the benefit is short term.
Several approaches have been described to repair rectoceles. Gynecologists and many colorectal surgeons prefer the transvaginal approach (posterior colporrhaphy). Other options include a transanal and perineal approach.