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External rectal prolapse may give symptoms of obstructed defecation syndrome, fecal incontinence, or both, [17] [6] Other symptoms are bloody or mucous rectal discharge. [6] Relative indications are: Internal rectal prolapse (rectal intussusception), if it causes symptoms. [20] Anterior rectocele, if large and causing symptoms. [5]
Cul-de-sac hernias may be classified as rectal, septal, or vaginal depending on the structure they herniate into. Rectal cul-de-sac hernias herniate into an internal or external rectal prolapse. Septal cul-de-sac hernias herniate into the recto-vaginal septum (rectovesical septum in males). Vaginal cul-de-sac hernias bulge into the vagina itself.
A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. [2] However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depending on whether the prolapsed section is visible externally, and whether the full or only partial thickness of the rectal wall is involved.
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However, the wounds created by the surgery are usually associated with considerable post-operative pain which necessitates a prolonged recovery period. This can put a stress on a general practitioner ’s resources, may alienate the patient and delays the patient's return to a full, normal lifestyle and the workplace.
Severe cases may cause vaginal bleeding, intermittent fecal incontinence, or even the prolapse of the bulge through the mouth of the vagina, or rectal prolapse through the anus. Digital evacuation, or, manual pushing, on the posterior wall of the vagina helps to aid in bowel movement in a majority of cases of rectocele.
The procedure reduces constipation and fecal incontinence in patients with rectal prolapse or rectal intussusception, and has a low rate of complications and recurrence. [64] The procedure is able to correct multiple anatomical defects associated with vaginal and rectal prolapse, as well as improving function in terms of continence and defecation.
Long term injury to the rectal mucosa and ischemic trauma are thought to be the main mechanisms. [5] In a report of 36 patients with SRUS, the underlying cause was internal prolapse (intussusception) in 20 patients, external rectal prolapse in 14 patients, and dyssynergic defecation (anismus) in 2 patients. [7]