Obstructed defecation syndrome(ODS)represents an important cause of constipation,primarily arising from dysfunctions within the pelvic floor.Characterized by an inability to complete defecation or effectively evacuate...Obstructed defecation syndrome(ODS)represents an important cause of constipation,primarily arising from dysfunctions within the pelvic floor.Characterized by an inability to complete defecation or effectively evacuate fecal material despite the urge to defecate,ODS results in a persistent sensation of incomplete evacuation and often requires excessive straining during defecation.Conventional clinical examinations fail to adequately assess the complex dynamic dysfunctions of the pelvic floor and anorectal region.Magnetic resonance defecography(MRD),a sophisticated form of dynamic pelvic floor imaging,provides a comprehensive,non-invasive means of visualizing and quantifying various anorectal and pelvic floor abnormalities.By allowing detailed assessment of structural and functional deficits during the defecation process,MRD plays a crucial role in the diagnostic workup of ODS,enabling colorectal surgeons to formulate more precise and individualized treatment strategies.This manuscript highlights the important anatomical and functional disorders of pelvic floor that are associated with ODS.展开更多
BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care....BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care.The condition is characterized by the urge to defecate but an impaired ability to expel the fecal bolus.ODS is associated with various anorectal abnormalities,which are not always apparent during a standard physical examination,requiring specialized imaging techniques for proper diagnosis.AIM To study the distribution of causes of ODS in patients with chronic constipation by magnetic resonance defecography(MRD).METHODS This observational study evaluated the causes of ODS in 57 patients with chronic constipation who presented to Bangabandhu Sheikh Mujib Medical University between July 2020 and June 2021.After obtaining institutional review board approval and informed consent,patients underwent history taking,physical exams,and relevant investigations.ODS was diagnosed using Rome III criteria,with colonoscopy ruling out organic causes.Standard MRD was performed in different phases,and images were analyzed by expert radiologists and reported in a stan-dardized format.RESULTS Pelvic floor descent and anorectal junction descent were the most frequent findings,each present in 94.7%of cases.Rectocele was observed in 78.9%of patients,while vaginal or uterine prolapse was seen in 59.4%of females.Less common abnormalities included paradoxical contraction(7%),and there were no cases of sigmoidocele.Functional measurements showed significant differences in pelvic floor dynamics between rest and defecation,particularly in the H-line,M-line,and descent of pelvic organs(P<0.05).CONCLUSION Pelvic floor descent and anorectal descent were the most common findings in patients suffering from ODS,fo-llowed by rectocele.Younger females(<30 years)were most affected.展开更多
BACKGROUND Over 90%of rectal cancer patients develop low anterior resection syndrome(LARS)after sphincter-preserving resection.The current globally recognized evaluation method has many drawbacks and its subjectivity ...BACKGROUND Over 90%of rectal cancer patients develop low anterior resection syndrome(LARS)after sphincter-preserving resection.The current globally recognized evaluation method has many drawbacks and its subjectivity is too strong,which hinders the research and treatment of LARS.AIM To evaluate the anorectal function after colorectal cancer surgery by quantifying the index of magnetic resonance imaging(MRI)defecography,and pathogenesis of LARS.METHODS We evaluated 34 patients using the standard LARS score,and a new LARS evaluation index was established using the dynamic images of MRI defecography to verify the LARS score.RESULTS In the LARS score model,there were 10(29.41%)mild and 24(70.58%)severe cases of LARS.The comparison of defecation rate between the two groups was 29.36±14.17%versus 46.83±18.62%(P=0.004);and MRI-rectal compliance(MRI-RC)score was 3.63±1.96 versus 7.0±3.21(P=0.001).Severe and mild LARS had significant differences using the two evaluation methods.There was a significant negative correlation between LARS and MRI-RC score(P<0.001),and they had a negative correlation with defecation rate(P=0.028).CONCLUSION MRI defecography and standard LARS score can both be used as an evaluation index to study the pathogenesis of LARS.展开更多
AIM: Evaluation of the wide range of normal findings in asymptomatic women undergoing dynamic magnetic resonance (MR) defecography. METHODS: MR defecography of 10 healthy female volunteers (median age: 31 years) witho...AIM: Evaluation of the wide range of normal findings in asymptomatic women undergoing dynamic magnetic resonance (MR) defecography. METHODS: MR defecography of 10 healthy female volunteers (median age: 31 years) without previous pregnancies or history of surgery were evaluated. The rectum was filled with 180 mL gadolinium ultrasound gel mixture. MR defecography was performed in the supine position. The pelvic floor was visualized with a dynamic T2-weighted sagittal plane where all relevant pelvic floor organs were acquired during defecation. The volunteers were instructed to relax and then to perform straining maneuvers to empty the rectum. The pubococcygeal line (PCGL) was used as the line of reference. The movement of pelvic floor organs was measured as the vertical distance to this reference line. Data were recorded in the resting position as well as during the defecation process with maximal straining. Examinations were performed and evaluated by two experienced abdominal radiologists without knowledge of patient history. RESULTS: Average position of the anorectal junction was located at -5.3 mm at rest and -29.9 mm during straining. The anorectal angle widened significantly from 93° at rest to 109° during defecation. A rectocele was diagnosed in eight out of 10 volunteers showing an average diameter of 25.9 mm. The bladder base was located at a position of +23 mm at rest and descended to -8.1 mm during defecation in relation to the PCGL. The bladder base moved below the PCGL in six out of 10 volunteers, which was formally defined as a cystocele. The uterocervical junction was located at an average level of +43.1 mm at rest and at +7.9 mm during straining. The uterocervical junction of three volunteers fell below the PCGL; described formally as uterocervical prolapse. CONCLUSION: Based on the range of standard values in asymptomatic volunteers, MR defecography values for pathological changes have to be re-evaluated.展开更多
Backround: Chronic constipation is a common, chronic and frequent problem of the general population. The aim of this study is to assess the efficacy of defecography in diagnosing the etiology of constipation and the r...Backround: Chronic constipation is a common, chronic and frequent problem of the general population. The aim of this study is to assess the efficacy of defecography in diagnosing the etiology of constipation and the relation between constipation and rectocele. Material-method: We have investigated 250 patients who have been admitted to our general surgery out-patient clinic with complaint of constipation using Rome III criteria and diagnostic defecography. Results: Out of 250 patients who were evaluated with defecography only 24 had normal findings. 136 patients were found to have rectocele. Conclusion: We propose that rectocele is an important etiology of constipation, and defecography should be considered early in the diagnosis of rectocele.展开更多
Obstructed defecation syndrome(ODS)is a complex defecatory disorder asso-ciated with pelvic floor dysfunction.It affects approximately 50%of women over the age of 50 and significantly impacts their quality of life.The...Obstructed defecation syndrome(ODS)is a complex defecatory disorder asso-ciated with pelvic floor dysfunction.It affects approximately 50%of women over the age of 50 and significantly impacts their quality of life.The causes of ODS include structural abnormalities such as rectocele,enterocele,intussusception,and pelvic floor descent,as well as functional disorders like anismus.Accurate diagnosis is crucial for effective management due to the high risk of treatment failure associated with inaccurate findings.Various imaging modalities are used to assess pelvic floor disorders,including fluoroscopic defecography(FD),mag-netic resonance defecography(MRD),pelvic floor ultrasound(PFUS),and echode-fecography(EDF).FD is the most commonly performed test worldwide,offering high accuracy in diagnosing pelvic floor disorders.It provides dynamic visual-ization of defecation mechanics but involves radiation exposure.MRD offers ex-cellent soft tissue detail and multiplanar imaging without radiation,making it particularly useful for multicompartment disorders;however,it is associated with high procedural costs and limited availability.Both PFUS and EDF are minimally invasive and avoid radiation exposure.PFUS shows promise as a valuable screening tool that could help minimize the need for advanced imaging if findings are normal.EDF is also promising but requires specialized training and remains less widely available.This review evaluates the accuracy,advantages,and limitations of various diagnostic modalities for pelvic floor disorders,aiming to guide optimal clinical decision-making.展开更多
In this editorial,we comment on an article by Wang et al.Recent literature shows an increase in research on pelvic organ prolapse(POP).Although the true incidence of POP remains uncertain,its impact on quality of life...In this editorial,we comment on an article by Wang et al.Recent literature shows an increase in research on pelvic organ prolapse(POP).Although the true incidence of POP remains uncertain,its impact on quality of life is substantial.Anatomical studies report high incidence rates,surpassing those observed in symptom-based surveys.Weakness of the endopelvic fascia is a primary anatomical risk factor for POP.Additionally,gestational diabetes mellitus(GDM)has emerged as a growing concern,as poor glycemic control increases complications for both mother and fetus.GDM and POP are interconnected,with factors like maternal obesity,macrosomia,and hormonal changes exacerbating pelvic floor dysfunction.Modifiable risk factors,such as obesity and chronic hyperglycemia,along with multiparity,instrumental deliveries,and obstetric trauma,further increase susceptibility.For patients with GDM,gynecological exams,Pelvic Organ Prolapse Quantification staging,and pelvic floor ultrasonography are valuable diagnostics,with proctological exams and magnetic resonance defecography aiding in multi-compartment prolapse diagnoses.Imaging,though uncomfortable during pregnancy,is safe in the early postpartum period.This editorial emphasizes the need for further research on the pathophysiology of GDM-related POP and offers recommendations for improving diagnosis and clinical management of patients with GDM.展开更多
Chronic constipation is a common and extremely troublesome disorder that significantly reduces the quality of life,and this fact is consistent with the high rate at which health care is sought for this condition.The a...Chronic constipation is a common and extremely troublesome disorder that significantly reduces the quality of life,and this fact is consistent with the high rate at which health care is sought for this condition.The aim of this project was to develop a consensus for the diagnosis and treatment of chronic constipation and obstructed defecation.The commission presents its results in a "Question-Answer" format,including a set of graded recommendations based on a systematic review of the literature and evidence-based medicine.This section represents the consensus for the diagnosis.The history includes information relating to the onset and duration of symptoms and may reveal secondary causes of constipation.The presence of alarm symptoms and risk factors requires investigation.The physical examination should assess the presence of lesions in the anal and perianal region.The evidence does not support the routine use of blood testing and colonoscopy or barium enema for constipation.Various scoring systems are available to quantify the severity of constipation;the Constipation Severity Instrument for constipation and the obstructed defecation syndrome score for obstructed defecation are the most reliable.The Constipation-Related Quality of Life is an excellent tool for evaluating the patient's quality of life.No single test provides a pathophysiological basis for constipation.Colonic transit and anorectal manometry define the pathophysiologic subtypes.Balloon expulsion is a simple screening test for defecatory disorders,but it does not define the mechanisms.Defecography detects structural abnormalities and assesses functional parameters.Magnetic resonance imaging and/or pelvic floor sonography can further complement defecography by providing information on the movement of the pelvic floor and the organs that it supports.All these investigations are indicated to differentiate between slow transit constipation and obstructed defecation because the treatments differ between these conditions.展开更多
AIM:To compare defecographic abnormalities in symptomatic men and women and to analyze differences between men and age-and symptom-matched women.METHODS:Sixty-six men(mean age:55.4 years,range:20-81 years) who complai...AIM:To compare defecographic abnormalities in symptomatic men and women and to analyze differences between men and age-and symptom-matched women.METHODS:Sixty-six men(mean age:55.4 years,range:20-81 years) who complained of constipation and/or fecal incontinence and/or pelvic pain underwent defecography after intake of a barium meal.Radiographs were analyzed for the diagnosis of rectocele,enterocele,intussusception and perineal descent.They were compared with age-and symptom-matched women(n = 198) who underwent defecography during the same period.RESULTS:Normal defecography was observed in 22.7% of men vs 5.5% of women(P < 0.001).Defecography in men compared with women showed 4.5%vs 44.4%(P < 0.001) rectocele,and 10.6% vs 29.8%(P < 0.001) enterocele,respectively.No difference was observed for the diagnosis of intussusception(57.6% vs 44.9%).Perineal descent at rest was more frequent in women(P < 0.005).CONCLUSION:For the same complaint,diagnosis of defecographic abnormalities was different in men than in women:rectocele,enterocele and perineal descent at rest were observed less frequently in men than in women.展开更多
In order to distinguish rectal rnucosal prolapse (RMP) from full thickness rectal intassusception(FTRI ). 66 patients with internal rectal prolapse and 36 normal controls were studied with defecopelvicography. Anorect...In order to distinguish rectal rnucosal prolapse (RMP) from full thickness rectal intassusception(FTRI ). 66 patients with internal rectal prolapse and 36 normal controls were studied with defecopelvicography. Anorectal angle,level of pelvic floor and other indices were measured. It was found that 41patients with RMP had no changes of the peritoneal cul-de-sac of pelvic floor and 25 patients with FTRI hadabnormal descent of the peritoneal cul-de-sac of pelvic floor. which formed the internal herniated sac of therectal wall. It is believed that defeco-pelvicography is a reliable method to distinguish RMP from FTRI,anddemonstrate coexistent internal herniated sac of the rectal wall. Our findings are helpful to plan proper management of internal rectal prolapse.展开更多
文摘Obstructed defecation syndrome(ODS)represents an important cause of constipation,primarily arising from dysfunctions within the pelvic floor.Characterized by an inability to complete defecation or effectively evacuate fecal material despite the urge to defecate,ODS results in a persistent sensation of incomplete evacuation and often requires excessive straining during defecation.Conventional clinical examinations fail to adequately assess the complex dynamic dysfunctions of the pelvic floor and anorectal region.Magnetic resonance defecography(MRD),a sophisticated form of dynamic pelvic floor imaging,provides a comprehensive,non-invasive means of visualizing and quantifying various anorectal and pelvic floor abnormalities.By allowing detailed assessment of structural and functional deficits during the defecation process,MRD plays a crucial role in the diagnostic workup of ODS,enabling colorectal surgeons to formulate more precise and individualized treatment strategies.This manuscript highlights the important anatomical and functional disorders of pelvic floor that are associated with ODS.
文摘BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care.The condition is characterized by the urge to defecate but an impaired ability to expel the fecal bolus.ODS is associated with various anorectal abnormalities,which are not always apparent during a standard physical examination,requiring specialized imaging techniques for proper diagnosis.AIM To study the distribution of causes of ODS in patients with chronic constipation by magnetic resonance defecography(MRD).METHODS This observational study evaluated the causes of ODS in 57 patients with chronic constipation who presented to Bangabandhu Sheikh Mujib Medical University between July 2020 and June 2021.After obtaining institutional review board approval and informed consent,patients underwent history taking,physical exams,and relevant investigations.ODS was diagnosed using Rome III criteria,with colonoscopy ruling out organic causes.Standard MRD was performed in different phases,and images were analyzed by expert radiologists and reported in a stan-dardized format.RESULTS Pelvic floor descent and anorectal junction descent were the most frequent findings,each present in 94.7%of cases.Rectocele was observed in 78.9%of patients,while vaginal or uterine prolapse was seen in 59.4%of females.Less common abnormalities included paradoxical contraction(7%),and there were no cases of sigmoidocele.Functional measurements showed significant differences in pelvic floor dynamics between rest and defecation,particularly in the H-line,M-line,and descent of pelvic organs(P<0.05).CONCLUSION Pelvic floor descent and anorectal descent were the most common findings in patients suffering from ODS,fo-llowed by rectocele.Younger females(<30 years)were most affected.
文摘BACKGROUND Over 90%of rectal cancer patients develop low anterior resection syndrome(LARS)after sphincter-preserving resection.The current globally recognized evaluation method has many drawbacks and its subjectivity is too strong,which hinders the research and treatment of LARS.AIM To evaluate the anorectal function after colorectal cancer surgery by quantifying the index of magnetic resonance imaging(MRI)defecography,and pathogenesis of LARS.METHODS We evaluated 34 patients using the standard LARS score,and a new LARS evaluation index was established using the dynamic images of MRI defecography to verify the LARS score.RESULTS In the LARS score model,there were 10(29.41%)mild and 24(70.58%)severe cases of LARS.The comparison of defecation rate between the two groups was 29.36±14.17%versus 46.83±18.62%(P=0.004);and MRI-rectal compliance(MRI-RC)score was 3.63±1.96 versus 7.0±3.21(P=0.001).Severe and mild LARS had significant differences using the two evaluation methods.There was a significant negative correlation between LARS and MRI-RC score(P<0.001),and they had a negative correlation with defecation rate(P=0.028).CONCLUSION MRI defecography and standard LARS score can both be used as an evaluation index to study the pathogenesis of LARS.
文摘AIM: Evaluation of the wide range of normal findings in asymptomatic women undergoing dynamic magnetic resonance (MR) defecography. METHODS: MR defecography of 10 healthy female volunteers (median age: 31 years) without previous pregnancies or history of surgery were evaluated. The rectum was filled with 180 mL gadolinium ultrasound gel mixture. MR defecography was performed in the supine position. The pelvic floor was visualized with a dynamic T2-weighted sagittal plane where all relevant pelvic floor organs were acquired during defecation. The volunteers were instructed to relax and then to perform straining maneuvers to empty the rectum. The pubococcygeal line (PCGL) was used as the line of reference. The movement of pelvic floor organs was measured as the vertical distance to this reference line. Data were recorded in the resting position as well as during the defecation process with maximal straining. Examinations were performed and evaluated by two experienced abdominal radiologists without knowledge of patient history. RESULTS: Average position of the anorectal junction was located at -5.3 mm at rest and -29.9 mm during straining. The anorectal angle widened significantly from 93° at rest to 109° during defecation. A rectocele was diagnosed in eight out of 10 volunteers showing an average diameter of 25.9 mm. The bladder base was located at a position of +23 mm at rest and descended to -8.1 mm during defecation in relation to the PCGL. The bladder base moved below the PCGL in six out of 10 volunteers, which was formally defined as a cystocele. The uterocervical junction was located at an average level of +43.1 mm at rest and at +7.9 mm during straining. The uterocervical junction of three volunteers fell below the PCGL; described formally as uterocervical prolapse. CONCLUSION: Based on the range of standard values in asymptomatic volunteers, MR defecography values for pathological changes have to be re-evaluated.
文摘Backround: Chronic constipation is a common, chronic and frequent problem of the general population. The aim of this study is to assess the efficacy of defecography in diagnosing the etiology of constipation and the relation between constipation and rectocele. Material-method: We have investigated 250 patients who have been admitted to our general surgery out-patient clinic with complaint of constipation using Rome III criteria and diagnostic defecography. Results: Out of 250 patients who were evaluated with defecography only 24 had normal findings. 136 patients were found to have rectocele. Conclusion: We propose that rectocele is an important etiology of constipation, and defecography should be considered early in the diagnosis of rectocele.
文摘Obstructed defecation syndrome(ODS)is a complex defecatory disorder asso-ciated with pelvic floor dysfunction.It affects approximately 50%of women over the age of 50 and significantly impacts their quality of life.The causes of ODS include structural abnormalities such as rectocele,enterocele,intussusception,and pelvic floor descent,as well as functional disorders like anismus.Accurate diagnosis is crucial for effective management due to the high risk of treatment failure associated with inaccurate findings.Various imaging modalities are used to assess pelvic floor disorders,including fluoroscopic defecography(FD),mag-netic resonance defecography(MRD),pelvic floor ultrasound(PFUS),and echode-fecography(EDF).FD is the most commonly performed test worldwide,offering high accuracy in diagnosing pelvic floor disorders.It provides dynamic visual-ization of defecation mechanics but involves radiation exposure.MRD offers ex-cellent soft tissue detail and multiplanar imaging without radiation,making it particularly useful for multicompartment disorders;however,it is associated with high procedural costs and limited availability.Both PFUS and EDF are minimally invasive and avoid radiation exposure.PFUS shows promise as a valuable screening tool that could help minimize the need for advanced imaging if findings are normal.EDF is also promising but requires specialized training and remains less widely available.This review evaluates the accuracy,advantages,and limitations of various diagnostic modalities for pelvic floor disorders,aiming to guide optimal clinical decision-making.
文摘In this editorial,we comment on an article by Wang et al.Recent literature shows an increase in research on pelvic organ prolapse(POP).Although the true incidence of POP remains uncertain,its impact on quality of life is substantial.Anatomical studies report high incidence rates,surpassing those observed in symptom-based surveys.Weakness of the endopelvic fascia is a primary anatomical risk factor for POP.Additionally,gestational diabetes mellitus(GDM)has emerged as a growing concern,as poor glycemic control increases complications for both mother and fetus.GDM and POP are interconnected,with factors like maternal obesity,macrosomia,and hormonal changes exacerbating pelvic floor dysfunction.Modifiable risk factors,such as obesity and chronic hyperglycemia,along with multiparity,instrumental deliveries,and obstetric trauma,further increase susceptibility.For patients with GDM,gynecological exams,Pelvic Organ Prolapse Quantification staging,and pelvic floor ultrasonography are valuable diagnostics,with proctological exams and magnetic resonance defecography aiding in multi-compartment prolapse diagnoses.Imaging,though uncomfortable during pregnancy,is safe in the early postpartum period.This editorial emphasizes the need for further research on the pathophysiology of GDM-related POP and offers recommendations for improving diagnosis and clinical management of patients with GDM.
基金Supported by Associazione Italiana Gastroenterologi and Endoscopisti Digestivi Ospedalieri via N Colajanni,4-00191 Roma,ItalySocietà Italiana di Chirurgia Colo-Rettale via Medici,23-10143Torino,Italy
文摘Chronic constipation is a common and extremely troublesome disorder that significantly reduces the quality of life,and this fact is consistent with the high rate at which health care is sought for this condition.The aim of this project was to develop a consensus for the diagnosis and treatment of chronic constipation and obstructed defecation.The commission presents its results in a "Question-Answer" format,including a set of graded recommendations based on a systematic review of the literature and evidence-based medicine.This section represents the consensus for the diagnosis.The history includes information relating to the onset and duration of symptoms and may reveal secondary causes of constipation.The presence of alarm symptoms and risk factors requires investigation.The physical examination should assess the presence of lesions in the anal and perianal region.The evidence does not support the routine use of blood testing and colonoscopy or barium enema for constipation.Various scoring systems are available to quantify the severity of constipation;the Constipation Severity Instrument for constipation and the obstructed defecation syndrome score for obstructed defecation are the most reliable.The Constipation-Related Quality of Life is an excellent tool for evaluating the patient's quality of life.No single test provides a pathophysiological basis for constipation.Colonic transit and anorectal manometry define the pathophysiologic subtypes.Balloon expulsion is a simple screening test for defecatory disorders,but it does not define the mechanisms.Defecography detects structural abnormalities and assesses functional parameters.Magnetic resonance imaging and/or pelvic floor sonography can further complement defecography by providing information on the movement of the pelvic floor and the organs that it supports.All these investigations are indicated to differentiate between slow transit constipation and obstructed defecation because the treatments differ between these conditions.
文摘AIM:To compare defecographic abnormalities in symptomatic men and women and to analyze differences between men and age-and symptom-matched women.METHODS:Sixty-six men(mean age:55.4 years,range:20-81 years) who complained of constipation and/or fecal incontinence and/or pelvic pain underwent defecography after intake of a barium meal.Radiographs were analyzed for the diagnosis of rectocele,enterocele,intussusception and perineal descent.They were compared with age-and symptom-matched women(n = 198) who underwent defecography during the same period.RESULTS:Normal defecography was observed in 22.7% of men vs 5.5% of women(P < 0.001).Defecography in men compared with women showed 4.5%vs 44.4%(P < 0.001) rectocele,and 10.6% vs 29.8%(P < 0.001) enterocele,respectively.No difference was observed for the diagnosis of intussusception(57.6% vs 44.9%).Perineal descent at rest was more frequent in women(P < 0.005).CONCLUSION:For the same complaint,diagnosis of defecographic abnormalities was different in men than in women:rectocele,enterocele and perineal descent at rest were observed less frequently in men than in women.
文摘In order to distinguish rectal rnucosal prolapse (RMP) from full thickness rectal intassusception(FTRI ). 66 patients with internal rectal prolapse and 36 normal controls were studied with defecopelvicography. Anorectal angle,level of pelvic floor and other indices were measured. It was found that 41patients with RMP had no changes of the peritoneal cul-de-sac of pelvic floor and 25 patients with FTRI hadabnormal descent of the peritoneal cul-de-sac of pelvic floor. which formed the internal herniated sac of therectal wall. It is believed that defeco-pelvicography is a reliable method to distinguish RMP from FTRI,anddemonstrate coexistent internal herniated sac of the rectal wall. Our findings are helpful to plan proper management of internal rectal prolapse.
