Treatment of Obstructed Defecation

 

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Abstract

Obstructed defecation is a common problem that adversely affects the quality of life for many patients. Known causes of obstructed defecation include pelvic dyssynergy, rectocele, rectal intussusception, enterocele, pelvic organ prolapse, and overt rectal prolapse. Management of this condition requires an understanding of urinary, defecatory, and sexual function to achieve an optimal outcome. The goal of surgical treatment is to restore the various pelvic organs to their appropriate anatomic positions. However, there is a poor correlation between anatomic and functional results. As the pelvis contains many structures, a pelvic support or function defect frequently affects other pelvic organs. Optimal outcomes can only be achieved by selecting appropriate treatment modalities that address all of the components of a patient's problem.

• References

• 1 Drossman DA, Li Z, Andruzzi E , et al. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci 1993; 38 (9) 1569-1580
  CrossrefPubMedGoogle Scholar
• 2 Stewart WF, Liberman JN, Sandler RS , et al. Epidemiology of constipation (EPOC) study in the United States: relation of clinical subtypes to sociodemographic features. Am J Gastroenterol 1999; 94 (12) 3530-3540
  CrossrefPubMedGoogle Scholar
• 3 Everhart JE, Go VL, Johannes RS, Fitzsimmons SC, Roth HP, White LR. A longitudinal survey of self-reported bowel habits in the United States. Dig Dis Sci 1989; 34 (8) 1153-1162
  CrossrefPubMedGoogle Scholar
• 4 Drossman DA, Thompson WG, Talley NJ , et al. Identification of sub-groups of functional bowel disorders. Gastroenterol Int 1990; 3: 159-172
  PubMedGoogle Scholar
• 5 Snooks SJ, Setchell M, Swash M, Henry MM. Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet 1984; 2 (8402) 546-550
  PubMedGoogle Scholar
• 6 Sultan AH, Monga AK, Stanton SL. The pelvic floor sequelae of childbirth. Br J Hosp Med 1996; 55 (9) 575-579
  PubMedGoogle Scholar
• 7 DeLancey JOL. Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol 1992; 166 (6 Pt 1) 1717-1724, discussion 1724–1728
  CrossrefPubMedGoogle Scholar
• 8 Peschers UM, Schaer GN, DeLancey JOL, Schuessler B. Levator ani function before and after childbirth. Br J Obstet Gynaecol 1997; 104 (9) 1004-1008
  PubMedGoogle Scholar
• 9 Gill EJ, Hurt WG. Pathophysiology of pelvic organ prolapse. Obstet Gynecol Clin North Am 1998; 25 (4) 757-769
  CrossrefPubMedGoogle Scholar
• 10 Norton PA, Baker JE, Sharp HC, Warenski JC. Genitourinary prolapse and joint hypermobility in women. Obstet Gynecol 1995; 85 (2) 225-228
  CrossrefPubMedGoogle Scholar
• 11 Smith AR. Role of connective tissue and muscle in pelvic floor dysfunction. Curr Opin Obstet Gynecol 1994; 6 (4) 317-319
  PubMedGoogle Scholar
• 12 Olson AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997; 85: 501-506
  PubMedGoogle Scholar
• 13 Preston DM, Lennard-Jones JE. Anismus in chronic constipation. Dig Dis Sci 1985; 30 (5) 413-418
  CrossrefPubMedGoogle Scholar
• 14 Wald A, Caruana BJ, Freimanis MG, Bauman DH, Hinds JP. Contributions of evacuation proctography and anorectal manometry to evaluation of adults with constipation and defecatory difficulty. Dig Dis Sci 1990; 35 (4) 481-487
  CrossrefPubMedGoogle Scholar
• 15 Kuijpers HC, Bleijenberg G. The spastic pelvic floor syndrome. A cause of constipation. Dis Colon Rectum 1985; 28 (9) 669-672
  CrossrefPubMedGoogle Scholar
• 16 Roberts JP, Womack NR, Hallan RI, Thorpe AC, Williams NS. Evidence from dynamic integrated proctography to redefine anismus. Br J Surg 1992; 79 (11) 1213-1215
  CrossrefPubMedGoogle Scholar
• 17 Fleshman JW, Dreznik Z, Cohen E, Fry RD, Kodner IJ. Balloon expulsion test facilitates diagnosis of pelvic floor outlet obstruction due to nonrelaxing puborectalis muscle. Dis Colon Rectum 1992; 35 (11) 1019-1025
  CrossrefPubMedGoogle Scholar
• 18 Whitehead WE, Wald A, Diamant NE, Enck P, Pemberton JH, Rao SS. Functional disorders of the anus and rectum. Gut 1999; 45 (Suppl 2) II55-II59
  CrossrefPubMedGoogle Scholar
• 19 Lau CW, Heymen S, Alabaz O, Iroatulam AJ, Wexner SD. Prognostic significance of rectocele, intussusception, and abnormal perineal descent in biofeedback treatment for constipated patients with paradoxical puborectalis contraction. Dis Colon Rectum 2000; 43 (4) 478-482
  CrossrefPubMedGoogle Scholar
• 20 Enck P. Biofeedback training in disordered defecation. A critical review. Dig Dis Sci 1993; 38 (11) 1953-1960
  CrossrefPubMedGoogle Scholar
• 21 Rao SS, Enck P, Loening-Baucke V. Biofeedback therapy for defecation disorders. Dig Dis 1997; 15 (Suppl 1) 78-92
  CrossrefPubMedGoogle Scholar
• 22 Diamant NE, Kamm MA, Wald A, Whitehead WE. AGA technical review on anorectal testing techniques. Gastroenterology 1999; 116 (3) 735-760
  CrossrefPubMedGoogle Scholar
• 23 Chiarioni G, Whitehead WE, Pezza V, Morelli A, Bassotti G. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology 2006; 130 (3) 657-664
  Google Scholar
• 24 Rao SSC, Seaton K, Miller M , et al. Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clin Gastroenterol Hepatol 2007; 5 (3) 331-338
  CrossrefPubMedGoogle Scholar
• 25 Chiarioni G, Salandini L, Whitehead WE. Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation. Gastroenterology 2005; 129 (1) 86-97
  CrossrefPubMedGoogle Scholar
• 26 Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead WE. Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation. Dis Colon Rectum 2007; 50 (4) 428-441
  CrossrefPubMedGoogle Scholar
• 27 Heymen S, Jones KR, Scarlett Y, Whitehead WE. Biofeedback treatment of constipation: a critical review. Dis Colon Rectum 2003; 46 (9) 1208-1217
  CrossrefPubMedGoogle Scholar
• 28 Burnett C, Whitehead WE, Drossman D. Psychological distress and impaired quality of life in patients with functional anorectal disorders. Gastroenterology 1998; 114: A729
  PubMedGoogle Scholar
• 29 Heymen S, Wexner SD, Gulledge AD. MMPI assessment of patients with functional bowel disorders. Dis Colon Rectum 1993; 36 (6) 593-596
  CrossrefPubMedGoogle Scholar
• 30 Nehra V, Bruce BK, Rath-Harvey DM, Pemberton JH, Camilleri M. Psychological disorders in patients with evacuation disorders and constipation in a tertiary practice. Am J Gastroenterol 2000; 95 (7) 1755-1758
  CrossrefPubMedGoogle Scholar
• 31 Dykes S, Smilgin-Humphreys S, Bass C. Chronic idiopathic constipation: a psychological enquiry. Eur J Gastroenterol Hepatol 2001; 13 (1) 39-44
  CrossrefPubMedGoogle Scholar
• 32 Koutsomanis D, Lennard-Jones JE, Roy AJ, Kamm MA. Controlled randomised trial of visual biofeedback versus muscle training without a visual display for intractable constipation. Gut 1995; 37 (1) 95-99
  CrossrefPubMedGoogle Scholar
• 33 Jones KR, Heymen S, Whitehead WE. Biofeedback for anorectal disorders. In: Drutz HP, Hershorn S, Diamant NE, , eds. Urogynaecology and Reconstructive Pelvic Surgery. London: Springer-Verlag; 2003: 313-325
  CrossrefGoogle Scholar
• 34 Joo JS, Agachan F, Wolff B, Nogueras JJ, Wexner SD. Initial North American experience with botulinum toxin type A for treatment of anismus. Dis Colon Rectum 1996; 39 (10) 1107-1111
  CrossrefPubMedGoogle Scholar
• 35 Hallan RI, Williams NS, Melling J, Waldron DJ, Womack NR, Morrison JFB. Treatment of anismus in intractable constipation with botulinum A toxin. Lancet 1988; 2 (8613) 714-717
  PubMedGoogle Scholar
• 36 Yu DH, Cui FD. Surgical treatment of puborectalis syndrome. J Pract Surg 1990; 10: 1599-1600
  PubMedGoogle Scholar
• 37 Barnes PRH, Hawley PR, Preston DM, Lennard-Jones JE. Experience of posterior division of the puborectalis muscle in the management of chronic constipation. Br J Surg 1985; 72 (6) 475-477
  CrossrefPubMedGoogle Scholar
• 38 Kamm MA, Hawley PR, Lennard-Jones JE. Lateral division of the puborectalis muscle in the management of severe constipation. Br J Surg 1988; 75 (7) 661-663
  CrossrefPubMedGoogle Scholar
• 39 Richardson AC. The anatomic defects in rectocele and enterocele. J Pelvic Surg 1995; 1: 214-221
  PubMedGoogle Scholar
• 40 Bartolo DC, Roe AM, Virjee J, Mortensen NJ, Locke-Edmunds JC. An analysis of rectal morphology in obstructed defaecation. Int J Colorectal Dis 1988; 3 (1) 17-22
  CrossrefPubMedGoogle Scholar
• 41 Turnbull GK, Bartram CI, Lennard-Jones JE. Radiologic studies of rectal evacuation in adults with idiopathic constipation. Dis Colon Rectum 1988; 31 (3) 190-197
  CrossrefPubMedGoogle Scholar
• 42 Sarles JC, Arnaud A, Selezneff I, Olivier S. Endo-rectal repair of rectocele. Int J Colorectal Dis 1989; 4 (3) 167-171
  CrossrefPubMedGoogle Scholar
• 43 Pfeifer J, Agachan F, Wexner SD. Surgery for constipation: a review. Dis Colon Rectum 1996; 39 (4) 444-460
  CrossrefPubMedGoogle Scholar
• 44 Arnold MW, Stewart WRC, Aguilar PS. Rectocele repair. Four years’ experience. Dis Colon Rectum 1990; 33 (8) 684-687
  CrossrefPubMedGoogle Scholar
• 45 Sehapayak S. Transrectal repair of rectocele: an extended armamentarium of colorectal surgeons. A report of 355 cases. Dis Colon Rectum 1985; 28 (6) 422-433
  CrossrefPubMedGoogle Scholar
• 46 van Dam JH, Huisman WM, Hop WCJ, Schouten WR. Fecal continence after rectocele repair: a prospective study. Int J Colorectal Dis 2000; 15 (1) 54-57
  CrossrefPubMedGoogle Scholar
• 47 Ayabaca SM, Zbar AP, Pescatori M. Anal continence after rectocele repair. Dis Colon Rectum 2002; 45 (1) 63-69
  CrossrefPubMedGoogle Scholar
• 48 Ting KH, Mangel E, Eibl-Eibesfeldt B, Müller-Lissner SA. Is the volume retained after defecation a valuable parameter at defecography?. Dis Colon Rectum 1992; 35 (8) 762-767
  CrossrefPubMedGoogle Scholar
• 49 Halligan S, Bartram CI. Is barium trapping in rectoceles significant?. Dis Colon Rectum 1995; 38 (7) 764-768
  CrossrefPubMedGoogle Scholar
• 50 Infantino A, Masin A, Melega E, Dodi G, Lise M. Does surgery resolve outlet obstruction from rectocele?. Int J Colorectal Dis 1995; 10 (2) 97-100
  CrossrefPubMedGoogle Scholar
• 51 Mellgren A, Anzén B, Nilsson BY , et al. Results of rectocele repair. A prospective study. Dis Colon Rectum 1995; 38 (1) 7-13
  CrossrefPubMedGoogle Scholar
• 52 Murthy VK, Orkin BA, Smith LE, Glassman LM. Excellent outcome using selective criteria for rectocele repair. Dis Colon Rectum 1996; 39 (4) 374-378
  CrossrefPubMedGoogle Scholar
• 53 Karlbom U, Graf W, Nilsson S, Påhlman L. Does surgical repair of a rectocele improve rectal emptying?. Dis Colon Rectum 1996; 39 (11) 1296-1302
  CrossrefPubMedGoogle Scholar
• 54 van Dam JH, Ginai AZ, Gosselink MJ , et al. Role of defecography in predicting clinical outcome of rectocele repair. Dis Colon Rectum 1997; 40 (2) 201-207
  CrossrefPubMedGoogle Scholar
• 55 Tjandra JJ, Ooi BS, Tang CL, Dwyer P, Carey M. Transanal repair of rectocele corrects obstructed defecation if it is not associated with anismus. Dis Colon Rectum 1999; 42 (12) 1544-1550
  CrossrefPubMedGoogle Scholar
• 56 Janssen LW, van Dijke CF. Selection criteria for anterior rectal wall repair in symptomatic rectocele and anterior rectal wall prolapse. Dis Colon Rectum 1994; 37 (11) 1100-1107
  CrossrefPubMedGoogle Scholar
• 57 van Dam JH, Hop WC, Schouten WR. Analysis of patients with poor outcome of rectocele repair. Dis Colon Rectum 2000; 43 (11) 1556-1560
  CrossrefPubMedGoogle Scholar
• 58 Jeffcoate TN. Posterior colpoperineorrhaphy. Am J Obstet Gynecol 1959; 77 (3) 490-502
  PubMedGoogle Scholar
• 59 Kahn MA, Stanton SL. Posterior colporrhaphy: its effects on bowel and sexual function. Br J Obstet Gynaecol 1997; 104 (1) 82-86
  CrossrefPubMedGoogle Scholar
• 60 Glavind K, Madsen H. A prospective study of the discrete fascial defect rectocele repair. Acta Obstet Gynecol Scand 2000; 79 (2) 145-147
  CrossrefPubMedGoogle Scholar
• 61 Kenton K, Shott S, Brubaker L. Outcome after rectovaginal fascia reattachment for rectocele repair. Am J Obstet Gynecol 1999; 181 (6) 1360-1363, discussion 1363–1364
  CrossrefPubMedGoogle Scholar
• 62 Porter WE, Steele A, Walsh P, Kohli N, Karram MM. The anatomic and functional outcomes of defect-specific rectocele repairs. Am J Obstet Gynecol 1999; 181 (6) 1353-1358, discussion 1358–1359
  CrossrefPubMedGoogle Scholar
• 63 Cundiff GW, Weidner AC, Visco AG, Addison WA, Bump RC. An anatomic and functional assessment of the discrete defect rectocele repair. Am J Obstet Gynecol 1998; 179 (6 Pt 1) 1451-1456, discussion 1456–1457
  CrossrefPubMedGoogle Scholar
• 64 Kahn MA, Stanton SL. Techniques of rectocele repair and their effects on bowel function. Int Urogynecol J Pelvic Floor Dysfunct 1998; 9 (1) 37-47
  CrossrefPubMedGoogle Scholar
• 65 Ryhammer AM, Laurberg S, Sørensen FH. Effects of age on anal function in normal women. Int J Colorectal Dis 1997; 12 (4) 225-229
  CrossrefPubMedGoogle Scholar
• 66 Zbar AP, Lienemann A, Fritsch H, Beer-Gabel M, Pescatori M. Rectocele: pathogenesis and surgical management. Int J Colorectal Dis 2003; 18 (5) 369-384
  CrossrefPubMedGoogle Scholar
• 67 Khubchandani IT, Sheets JA, Stasik JJ, Hakki AR. Endorectal repair of rectocele. Dis Colon Rectum 1983; 26 (12) 792-796
  CrossrefPubMedGoogle Scholar
• 68 Kahn MA, Stanton SL, Kumar DA. Randomized prospective trial of posterior colporrhaphy vs transanal repair of rectocele: preliminary findings. Int Urogynecol J 1997; 8: 246-247
  PubMedGoogle Scholar
• 69 Pitchford CA. Rectocele: a cause of anorectal pathologic changes in women. Dis Colon Rectum 1967; 10 (6) 464-466
  CrossrefPubMedGoogle Scholar
• 70 Sullivan ES, Leaverton GH, Hardwick CE. Transrectal perineal repair: an adjunct to improved function after anorectal surgery. Dis Colon Rectum 1968; 11 (2) 106-114
  CrossrefPubMedGoogle Scholar
• 71 Khubchandani IT, Clancy III JP, Rosen L, Riether RD, Stasik Jr JJ. Endorectal repair of rectocele revisited. Br J Surg 1997; 84 (1) 89-91
  CrossrefPubMedGoogle Scholar
• 72 Ho YH, Ang M, Nyam D, Tan M, Seow-Choen F. Transanal approach to rectocele repair may compromise anal sphincter pressures. Dis Colon Rectum 1998; 41 (3) 354-358
  CrossrefPubMedGoogle Scholar
• 73 Schouten WR, Gordon PH. Constipation. In: Gordon PH, Nivatvongs S, , eds. Principles and Practice of Surgery for the Colon, Rectum, and Anus. St. Louis, MO: Quality Medical Publishing; 1999: 1214-1218
  Google Scholar
• 74 Ellis CN. Anterior levatoroplasty for the treatment of chronic anterior anal fissures in women with an associated rectocele. Dis Colon Rectum 2004; 47: 1170-1174
  CrossrefPubMedGoogle Scholar
• 75 Marti MC, Roche B, Deléaval J. Rectoceles: value of video-defecography in selection of treatment policy. Colorectal Dis 1999; 1: 324-329
  CrossrefPubMedGoogle Scholar
• 76 Van Laarhoven CJ, Kamm MA, Bartram CI, Halligan S, Hawley PR, Phillips RK. Relationship between anatomic and symptomatic long-term results after rectocele repair for impaired defecation. Dis Colon Rectum 1999; 42 (2) 204-210, discussion 210–211
  CrossrefPubMedGoogle Scholar
• 77 Block IR. Transrectal repair of rectocele using obliterative suture. Dis Colon Rectum 1986; 29 (11) 707-711
  CrossrefPubMedGoogle Scholar
• 78 Pescatori M, Favetta U, Dedola S , et al. Transanal stapled excision of rectal mucosal prolapse. Tech Coloproctol 1997; 1: 96-98
  PubMedGoogle Scholar
• 79 Altomare DF, Rinaldi M, Veglia A, Petrolino M, De Fazio M, Sallustio P. Combined perineal and endorectal repair of rectocele by circular stapler: a novel surgical technique. Dis Colon Rectum 2002; 45 (11) 1549-1552
  CrossrefPubMedGoogle Scholar
• 80 Longo A. Obstructed defecation because of rectal pathologies. Novel surgical treatment: stapled transanal resection (STARR). Paper presented at: The Annual Cleveland Clinic Foundation Colorectal Disease Symposium 2004; February 12–14, 2004; Ft. Lauderdale, FL
  PubMedGoogle Scholar
• 81 Boccasanta P, Venturi M, Stuto A , et al. Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial. Dis Colon Rectum 2004; 47 (8) 1285-1296, discussion 1296–1297
  CrossrefPubMedGoogle Scholar
• 82 Boccasanta P, Venturi M, Salamina G, Cesana BM, Bernasconi F, Roviaro G. New trends in the surgical treatment of outlet obstruction: clinical and functional results of two novel transanal stapled techniques from a randomised controlled trial. Int J Colorectal Dis 2004; 19 (4) 359-369
  CrossrefPubMedGoogle Scholar
• 83 Jayne DG, Schwandner O, Stuto A. Stapled transanal rectal resection for obstructed defecation syndrome: one-year results of the European STARR Registry. Dis Colon Rectum 2009; 52 (7) 1205-1212, discussion 1212–1214
  CrossrefPubMedGoogle Scholar
• 84 Titu LV, Riyad K, Carter H, Dixon AR. Stapled transanal rectal resection for obstructed defecation: a cautionary tale. Dis Colon Rectum 2009; 52 (10) 1716-1722
  CrossrefPubMedGoogle Scholar
• 85 Dodi G, Pietroletti R, Milito G, Binda G, Pescatori M. Bleeding, incontinence, pain and constipation after STARR transanal double stapling rectotomy for obstructed defecation. Tech Coloproctol 2003; 7 (3) 148-153
  CrossrefPubMedGoogle Scholar
• 86 Pescatori M, Dodi G, Salafia C, Zbar AP. Rectovaginal fistula after double-stapled transanal rectotomy (STARR) for obstructed defecation. Int J Colorectal Dis 2005; 20 (1) 83-85
  CrossrefPubMedGoogle Scholar
• 87 Watson SJ, Loder PB, Halligan S, Bartram CI, Kamm MA, Phillips RK. Transperineal repair of symptomatic rectocele with Marlex mesh: a clinical, physiological and radiologic assessment of treatment. J Am Coll Surg 1996; 183 (3) 257-261
  PubMedGoogle Scholar
• 88 Hoffman MJ, Kodner IJ, Fry RD. Internal intussusception of the rectum. Diagnosis and surgical management. Dis Colon Rectum 1984; 27 (7) 435-441
  CrossrefPubMedGoogle Scholar
• 89 Mellgren A, Schultz I, Johansson C, Dolk A. Internal rectal intussusception seldom develops into total rectal prolapse. Dis Colon Rectum 1997; 40 (7) 817-820
  CrossrefPubMedGoogle Scholar
• 90 Freimanis MG, Wald A, Caruana B, Bauman DH. Evacuation proctography in normal volunteers. Invest Radiol 1991; 26 (6) 581-585
  CrossrefPubMedGoogle Scholar
• 91 Shorvon PJ, McHugh S, Diamant NE, Somers S, Stevenson GW. Defecography in normal volunteers: results and implications. Gut 1989; 30 (12) 1737-1749
  CrossrefPubMedGoogle Scholar
• 92 van Tets WF, Kuijpers JHC. Internal rectal intussusception—fact or fancy?. Dis Colon Rectum 1995; 38 (10) 1080-1083
  CrossrefPubMedGoogle Scholar
• 93 Brown AJ, Anderson JH, McKee RF, Finlay IG. Surgery for occult rectal prolapse. Colorectal Dis 2004; 6 (3) 176-179
  CrossrefPubMedGoogle Scholar
• 94 Kelvin FM, Maglinte DD, Benson JT. Evacuation proctography (defecography): an aid to the investigation of pelvic floor disorders. Obstet Gynecol 1994; 83 (2) 307-314
  PubMedGoogle Scholar
• 95 Farouk R, Duthie GS, MacGregor AB, Bartolo DC. Rectoanal inhibition and incontinence in patients with rectal prolapse. Br J Surg 1994; 81 (5) 743-746
  CrossrefPubMedGoogle Scholar
• 96 Briel JW, Schouten WR, Boerma MO. Long-term results of suture rectopexy in patients with fecal incontinence associated with incomplete rectal prolapse. Dis Colon Rectum 1997; 40 (10) 1228-1232
  CrossrefPubMedGoogle Scholar
• 97 Rutter KRP. Solitary rectal ulcer syndrome; its relation to mucosal prolapse. Clin Gastroenterol 1985; 4: 505-530
  PubMedGoogle Scholar
• 98 Goei R, Baeten C, Arends JW. Solitary rectal ulcer syndrome: findings at barium enema study and defecography. Radiology 1988; 168 (2) 303-306
  PubMedGoogle Scholar
• 99 Kuijpers HC, Schreve RH, ten Cate Hoedemakers H. Diagnosis of functional disorders of defecation causing the solitary rectal ulcer syndrome. Dis Colon Rectum 1986; 29 (2) 126-129
  CrossrefPubMedGoogle Scholar
• 100 Halligan S, Nicholls RJ, Bartram CI. Evacuation proctography in patients with solitary rectal ulcer syndrome: anatomic abnormalities and frequency of impaired emptying and prolapse. AJR Am J Roentgenol 1995; 164 (1) 91-95
  CrossrefPubMedGoogle Scholar
• 101 Tjandra JJ, Fazio VW, Church JM, Lavery IC, Oakley JR, Milsom JW. Clinical conundrum of solitary rectal ulcer. Dis Colon Rectum 1992; 35 (3) 227-234
  CrossrefPubMedGoogle Scholar
• 102 Binnie NR, Papachrysostomou M, Clare N, Smith AN. Solitary rectal ulcer: the place of biofeedback and surgery in the treatment of the syndrome. World J Surg 1992; 16 (5) 836-840
  CrossrefPubMedGoogle Scholar
• 103 Halligan S, Nicholls RJ, Bartram CI. Proctographic changes after rectopexy for solitary rectal ulcer syndrome and preoperative predictive factors for a successful outcome. Br J Surg 1995; 82 (3) 314-317
  CrossrefPubMedGoogle Scholar
• 104 Berman IR, Harris MS, Rabeler MB. Delorme's transrectal excision for internal rectal prolapse. Patient selection, technique, and three-year follow-up. Dis Colon Rectum 1990; 33 (7) 573-580
  CrossrefPubMedGoogle Scholar
• 105 Christiansen J, Zhu BW, Rasmussen OO, Sørensen M. Internal rectal intussusception: results of surgical repair. Dis Colon Rectum 1992; 35 (11) 1026-1028, discussion 1028–1029
  CrossrefPubMedGoogle Scholar
• 106 Sielezneff I, Malouf A, Cesari J, Brunet C, Sarles JC, Sastre B. Selection criteria for internal rectal prolapse repair by Delorme's transrectal excision. Dis Colon Rectum 1999; 42 (3) 367-373
  CrossrefPubMedGoogle Scholar
• 107 Graf W, Karlbom U, Påhlman L, Nilsson S, Ejerblad S. Functional results after abdominal suture rectopexy for rectal prolapse or intussusception. Eur J Surg 1996; 162 (11) 905-911
  PubMedGoogle Scholar
• 108 McCue JL, Thomson JPS. Rectopexy for internal rectal intussusception. Br J Surg 1990; 77 (6) 632-634
  CrossrefPubMedGoogle Scholar
• 109 Mellgren A, Bremmer S, Johansson C , et al. Defecography. Results of investigations in 2,816 patients. Dis Colon Rectum 1994; 37 (11) 1133-1141
  CrossrefPubMedGoogle Scholar
• 110 Mellgren A, Johansson C, Dolk A , et al. Enterocele demonstrated by defecography is associated with other pelvic floor disorders. Int J Colorectal Dis 1994; 3: 121-124
  PubMedGoogle Scholar
• 111 Tulikangas PK, Piedmonte MR, Weber AM. Functional and anatomic follow-up of enterocele repairs. Obstet Gynecol 2001; 98 (2) 265-268
  CrossrefPubMedGoogle Scholar
• 112 Kobashi KC, Leach GE. Pelvic prolapse. J Urol 2000; 164 (6) 1879-1890
  CrossrefPubMedGoogle Scholar
• 113 Vanbeckevoort D, Van Hoe L, Oyen R, Ponette E, De Ridder D, Deprest J. Pelvic floor descent in females: comparative study of colpocystodefecography and dynamic fast MR imaging. J Magn Reson Imaging 1999; 9 (3) 373-377
  CrossrefPubMedGoogle Scholar
• 114 Wiskind AK, Creighton SM, Stanton SL. The incidence of genital prolapse after the Burch colposuspension. Am J Obstet Gynecol 1992; 167 (2) 399-404, discussion 404–405
  PubMedGoogle Scholar
• 115 Chaliha C, Stanton SL. Complications of surgery for genuine stress incontinence. Br J Obstet Gynaecol 1999; 106 (12) 1238-1245
  PubMedGoogle Scholar
• 116 Zimmern PE, Leach GE, Ganabathi K. The urological aspects of vaginal vault prolapse. Diagnosis and surgical aspects. AUA Update Series 1993; XII: 193-212
  PubMedGoogle Scholar
• 117 Timmons MC, Addison WA, Addison SB, Cavenar MG. Abdominal sacral colpopexy in 163 women with posthysterectomy vaginal vault prolapse and enterocele. Evolution of operative techniques. J Reprod Med 1992; 37 (4) 323-327
  PubMedGoogle Scholar
• 118 Zimmern PE, Leach GE. Repair of enterocele and rectocele, perineal repair, and vault suspension. Atlas Urol Clin North Am 1994; 2: 47-60
  PubMedGoogle Scholar
• 119 Benson JT, Lucente V, McClellan E. Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol 1996; 175 (6) 1418-1421, discussion 1421–1422
  CrossrefPubMedGoogle Scholar
• 120 Miklos JR, Kohli N, Lucente V, Saye WB. Site-specific fascial defects in the diagnosis and surgical management of enterocele. Am J Obstet Gynecol 1998; 179 (6 Pt 1) 1418-1422, discussion 1822–1823
  CrossrefPubMedGoogle Scholar
• 121 Gosselink MJ, van Dam JH, Huisman WM, Ginai AZ, Schouten WR. Treatment of enterocele by obliteration of the pelvic inlet. Dis Colon Rectum 1999; 42 (7) 940-944
  CrossrefPubMedGoogle Scholar
• 122 Jean F, Tanneau Y, Le Blanc-Louvry I, Leroi AM, Denis P, Michot F. Treatment of enterocele by abdominal colporectosacropexy - efficacy on pelvic pressure. Colorectal Dis 2002; 4 (5) 321-325
  CrossrefPubMedGoogle Scholar
• 123 Mellgren A, Dolk A, Johansson C, Bremmer S, Anzén B, Holmström B. Enterocele is correctable using the Ripstein rectopexy. Dis Colon Rectum 1994; 37 (8) 800-804
  CrossrefPubMedGoogle Scholar
• 124 Oettle GJ, Roe AM, Bartolo DC, Mortensen NJ. What is the best way of measuring perineal descent? A comparison of radiographic and clinical methods. Br J Surg 1985; 72 (12) 999-1001
  CrossrefPubMedGoogle Scholar
• 125 Lubowski DZ, Jones PN, Swash M, Henry MM. Asymmetrical pudendal nerve damage in pelvic floor disorders. Int J Colorectal Dis 1988; 3 (3) 158-160
  CrossrefPubMedGoogle Scholar
• 126 Sullivan ES, Longaker CJ, Lee PYH. Total pelvic mesh repair: a ten-year experience. Dis Colon Rectum 2001; 44 (6) 857-863
  CrossrefPubMedGoogle Scholar
• 127 Lahr SJ, Lahr CJ, Srinivasan A, Clerico ET, Limehouse VM, Serbezov IK. Operative management of severe constipation. Am Surg 1999; 65 (12) 1117-1121, discussion 1122–1123
  PubMedGoogle Scholar
• 128 Welgoss JA, Vogt VY, McClellan EJ, Benson JT. Relationship between surgically induced neuropathy and outcome of pelvic organ prolapse surgery. Int Urogynecol J Pelvic Floor Dysfunct 1999; 10 (1) 11-14
  CrossrefPubMedGoogle Scholar
• 129 Benson JT, McClellan E. The effect of vaginal dissection on the pudendal nerve. Obstet Gynecol 1993; 82 (3) 387-389
  PubMedGoogle Scholar
• 130 Benson JT. Defect approach to pelvic organ prolapse surgery. In: Stanton SL, Zimmern PE, , eds. Female Pelvic Reconstructive Surgery. London: Springer-Verlag; 2003: 365-368
  Google Scholar
• 131 Silvis R, Gooszen HG, Kahraman T , et al. Novel approach to combined defaecation and micturition disorders with rectovaginovesicopexy. Br J Surg 1998; 85 (6) 813-817
  CrossrefPubMedGoogle Scholar
• 132 Iglesia CB, Fenner DE, Brubaker L. The use of mesh in gynecologic surgery. Int Urogynecol J Pelvic Floor Dysfunct 1997; 8 (2) 105-115
  CrossrefPubMedGoogle Scholar