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Horny coed Svetlana is getting her tight teen ass pounded 8 min Chick Pass - STARR , and these patients may benefit from post-operative biofeedback therapy.

Decreased squeeze and resting pressures are usually the findings, and this may predate the development of the prolapse.

May be used to evaluate incontinence, but there is disagreement about what relevance the results may show, as rarely do they mandate a change of surgical plan.

Rectal prolapse is a "falling down" of the rectum so that it is visible externally. The appearance is of a reddened, proboscis-like object through the anal sphincters.

Patients find the condition embarrassing. The true incidence of rectal prolapse is unknown, but it is thought to be uncommon. As most sufferers are elderly, the condition is generally under-reported.

It is rare in men over 45 and in women under Anatomical differences such as the wider pelvic outlet in females may explain the skewed gender distribution.

Associated conditions, especially in younger patients include autism, developmental delay syndromes and psychiatric conditions requiring several medications.

Initially, the mass may protrude through the anal canal only during defecation and straining, and spontaneously return afterwards. Later, the mass may have to be pushed back in following defecation.

This may progress to a chronically prolapsed and severe condition, defined as spontaneous prolapse that is difficult to keep inside, and occurs with walking, prolonged standing, [5] coughing or sneezing Valsalva maneuvers.

If the prolapse becomes trapped externally outside the anal sphincters, it may become strangulated and there is a risk of perforation. The precise cause is unknown, [3] [9] [8] and has been much debated.

This theory was based on the observation that rectal prolapse patients have a mobile and unsupported pelvic floor, and a hernia sac of peritoneum from the Pouch of Douglas and rectal wall can be seen.

Shortly after the invention of defecography , In Broden and Snellman used cinedefecography to show that rectal prolapse begins as a circumferential intussusception of the rectum, [3] [9] which slowly increases over time.

Since most patients with rectal prolapse have a long history of constipation, [9] it is thought that prolonged, excessive and repetitive straining during defecation may predispose to rectal prolapse.

Some authors question whether these abnormalities are the cause, or secondary to the prolapse. Some authors suggest that pudendal nerve damage is the cause for pelvic floor and anal sphincter weakening, and may be the underlying cause of a spectrum of pelvic floor disorders.

Sphincter function in rectal prolapse is almost always reduced. Alternatively, the intussuscepting rectum may lead to chronic stimulation of the rectoanal inhibitory reflex RAIR - contraction of the external anal sphincter in response to stool in the rectum.

The RAIR was shown to be absent or blunted. Squeeze maximum voluntary contraction pressures may be affected as well as the resting tone.

This is most likely a denervation injury to the external anal sphincter. The assumed mechanism of fecal incontinence in rectal prolapse is by the chronic stretch and trauma to the anal sphincters and the presence of a direct conduit the intussusceptum connecting rectum to the external environment which is not guarded by the sphincters.

The assumed mechanism of obstructed defecation is by disruption to the rectum and anal canal's ability to contract and fully evacuate rectal contents.

The intussusceptum itself may mechanically obstruct the rectoanal lumen , creating a blockage that straining, anismus and colonic dysmotility exacerbate.

Some believe that internal rectal intussusception represents the initial form of a progressive spectrum of disorders the extreme of which is external rectal prolapse.

The intermediary stages would be gradually increasing sizes of intussusception. However, internal intussusception rarely progresses to external rectal prolapse.

Surgery is thought to be the only option to potentially cure a complete rectal prolapse. Dietary adjustments, including increasing dietary fiber may be beneficial to reduce constipation, and thereby reduce straining.

Surgery is often required to prevent further damage to the anal sphincters. The goals of surgery are to restore the normal anatomy and to minimize symptoms.

There is no globally agreed consensus as to which procedures are more effective, [6] and there have been over 50 different operations described.

Surgical approaches in rectal prolapse can be either perineal or abdominal. A perineal approach or trans-perineal refers to surgical access to the rectum and sigmoid colon via incision around the anus and perineum the area between the genitals and the anus.

Procedures for rectal prolapse may involve fixation of the bowel rectopexy , or resection a portion removed , or both. The abdominal approach carries a small risk of impotence in males e.

Laparoscopic procedures Recovery time following laparoscopic surgery is shorter and less painful than following traditional abdominal surgery.

The perineal approach generally results in less post-operative pain and complications, and a reduced length of hospital stay. These procedures generally carry a higher recurrence rate and poorer functional outcome.

The goal of Perineal rectosigmoidectomy is to resect, or remove, the redundant bowel. This is done through the perineum.

The lower rectum is anchored to the sacrum through fibrosis in order to prevent future prolapse. Redundant rectal and sigmoid wall is removed and the new edge of colon is reconnected anastomosed with the anal canal with stitches or staples.

This is a modification of the perineal rectosigmoidectomy, differing in that only the mucosa and submucosa are excised from the prolapsed segment, rather than full thickness resection.

The muscle layer that is left is plicated folded and placed as a buttress above the pelvic floor. This procedure can be carried out under local anaesthetic.

After reduction of the prolapse, a subcutaneous suture a stich under the skin or other material is placed encircling the anus, which is then made taut to prevent further prolapse.

Complications include breakage of the encirclement material, fecal impaction, sepsis, and erosion into the skin or anal canal. Recurrence rates are higher that the other perineal procedures.

This procedure is most often used for people who have a severe condition or who have a high risk of adverse effects from general anesthetic, [6] and who may not tolerate other perineal procedures.

Internal rectal intussusception rectal intussusception, internal intussusception, internal rectal prolapse, occult rectal prolapse, internal rectal procidentia and rectal invagination is a medical condition defined as a funnel shaped infolding of the rectal wall that can occur during defecation.

This phenomenon was first described in the late s when defecography was first developed and became widespread. Internal intussusception may be asymptomatic , but common symptoms include: [3].

Recto-rectal intussusceptions may be asymptomatic , apart from mild obstructed defecation. Recto-anal intussusceptions commonly give more severe symptoms of straining, incomplete evacuation, need for digital evacuation of stool, need for support of the perineum during defecation, urgency, frequency or intermittent fecal incontinence.

There are two schools of thought regarding the nature of internal intussusception, viz: whether it is a primary phenomenon, or secondary to a consequence of another condition.

Some believe that it represents the initial form of a progressive spectrum of disorders the extreme of which is external rectal prolapse.

The folding section of rectum can cause repeated trauma to the mucosa, and can cause solitary rectal ulcer syndrome. Others argue that the majority of patients appear to have rectal intussusception as a consequence of obstructed defecation rather than a cause, [34] [35] possibly related to excessive straining in patients with obstructed defecation.

They reported abnormalities of the enteric nervous system and estrogen receptors. The following conditions occur more commonly in patients with internal rectal intussusception than in the general population:.

Unlike external rectal prolapse, internal rectal intussusception is not visible externally, but it may still be diagnosed by digital rectal examination , while the patient strains as if to defecate.

Some have advocated the use of anorectal physiology testing anorectal manometry. Non surgical measures to treat internal intussusception include pelvic floor retraining, [44] a bulking agent e.

As with external rectal prolapse, there are a great many different surgical interventions described. Generally, a section of rectal wall can be resected removed , or the rectum can be fixed rectopexy to its original position against the sacral vertebrae , or a combination of both methods.

Surgery for internal rectal prolapse can be via the abdominal approach or the transanal approach. It is clear that there is a wide spectrum of symptom severity, meaning that some patients may benefit from surgery and others may not.

Many procedures receive conflicting reports of success, leading to a lack of any consensus about the best way to manage this problem.

Two of the most commonly employed procedures are discussed below. This procedure aims to "[correct] the descent of the posterior and middle pelvic compartments combined with reinforcement of the rectovaginal septum".

Rectopexy has been shown to improve anal incontinence fecal leakage in patients with rectal intussusception.

Complications include constipation, which is reduced if the technique does not use posterior rectal mobilization freeing the rectum from its attached back surface.

The advantage of the laproscopic approach is decreased healing time and less complications. This operation aims to "remove the anorectal mucosa circumferential and reinforce the anterior anorectal junction wall with the use of a circular stapler".

Since, specialized circular staplers have been developed for use in external rectal prolapse and internal rectal intussusception.

Complications, sometimes serious, have been reported following STARR, [53] [54] [54] [55] [56] [57] but the procedure is now considered safe and effective.

The anal sphincter may also be stretched during the operation. STARR was compared with biofeedback and found to be more effective at reducing symptoms and improving quality of life.

Rectal mucosal prolapse mucosal prolapse, anal mucosal prolapse is a sub-type of rectal prolapse, and refers to abnormal descent of the rectal mucosa through the anus.

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