Rectoanal Intussusception, Solitary Rectal Ulcer, and Sigmoidoceles

Successful defecation requires the smooth coordination of neurologic and muscular events by the pelvic floor and rectum.Deterioration of a single component of this process may lead to symptomatic rectal dysfunction manifested as constipation from the inability to evacuate. Prolonged untreated dysfunction with straining may ultimately lead to occult or overt rectal prolapse with concomitant rectal ulceration or fecal incontinence. The etiology of rectal dysfunction remains obscure but is believed to be multi-factorial in nature, involving electromyogenic, psychologic, aging, and hormonal mechanisms. In addition, rectal dysfunction is usually one component of a pathophysiologic process that involves the entire pelvic floor. As a result, several clinical manifestations may occur together or separately as part of the spectrum of this disease process and include nonrelaxation of the puborectalis muscle,rectoanal intussusception, rectal prolapse, perineal descent, solitary rectal ulcer syndrome (SRUS), rectocele, sigmoidocele, and hemorrhoids. Consequently, the therapeutic approach to rectal dysfunction is multifactorial, with the primary focus on bowel and pelvic floor retraining, behavioral modifications, and, less frequently, surgical interventions. This chapter will primarily address rectoanal intussusception, solitary rectal ulcer, and sigmoidoceles.