Incidence of occult rectal prolapse in patients with clinical rectoceles and defecatory dysfunction
Drs. Jason R. Thompson, Anita H. Chen, Paul D. M. Pettit, Melinia D. Bridges

Objective: To determine the incidence of occult rectal prolapse (rectal intussusception) via defecating proctography in patients with clinical rectoceles and defecatory dysfunction.
Methods: Patients presenting from 9/2000 thru  8/2001 with defecatory dysfunction and clinical
rectoceles underwent single contrast defecating proctography. Studies were interpreted by radiologists specializing in GI fluoroscopy. Results were retrieved from a computerized database.
Results: 60 patients meeting inclusion criteria were evaluated. Findings are depicted in the following table:

All but one intussusception was associated with a rectocele radiographically. Anismus (paradoxical contraction of the puborectalis) was associated with rectoceles radiographically except in one patient where it was the sole finding.
Conclusions : The data suggest an incidence of occult rectal prolapse in patients with clinical rectoceles and defecatory dysfunction to be 32%. This is highly clinically significant as a third of patients presenting for evaluation of defecatory dysfunction and rectocele may require sigmoid resection rectopexy along with other reconstructive procedures in order to restore pelvic floor function and prevent symptomatic recurrence.