Preoperative Evaluation

Verification of the rectal prolapse and differentiating it from hemorrhoids and/or mucosal prolapse is usually the first step in the examination of patients with a history suggestive of rectal prolapse. Rectal prolapse is identified as a circular, full-thickness prolapse extending outside the anal verge when the patient strains. Occasionally the patient is unable to reproduce their prolapse at clinical examination in the left lateral position. Examination in the sitting position on a commode or diagnosis using defecography may then be quite helpful (Mellgren et al, 1994).

The patient history should include preoperative constipation and incontinence symptoms, bowel frequency, obstetric history, and other associated pelvic floor disorders, such as co-existing urinary incontinence or genital prolapse. Patients with rectal prolapse are at an increased risk for other concomitant pelvic floor abnormalities.

The clinical examination includes inspection of the perineum. Digital examination will assess the resting and squeeze tones of the anal sphincters. Proctoscopy or endoscopy will frequently reveal an area of mild erythema within the lower rectum. Sometimes a solitary rectal ulcer will be found in the mid-rectum. This may sometimes be difficult to distinguish from a polyp or tumor, and biopsies may therefore be needed. Evaluation of the remaining colon is encouraged, to exclude any coexisting colorectal pathology, particularly cancer. Solitary rectal ulcer syndrome (SRUS) is discussed later in this chapter.

Colon transit studies, anorectal manometry, pudendal latencies and endo-anal ultrasound may also be used in the examination of prolapse patients, but they are usually not essential for the preoperative assessment.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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