Rectal prolapse - Knowledge

864:

line. 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 procedure may be combined with levatorplasty, to tighten the pelvic muscles. A combined a perineal proctosigmoidectomy with anterior levatorplasty is also called an Altemeier procedure. Levatorplasty is performed to correct levator diastasis which is commonly associated with rectal prolapse. Perineal rectosigmoidectomy was first introduced by Mikulicz in 1899, and it remained the preferred treatment in Europe for many years. It was Popularized by Altemeier. The procedure is simple, safe and effective. Continence levatorplasty may enhance restoration of continence (2/3 of patients). Complications occur in less than 10% of cases, and include pelvic bleeding, pelvic abscess and anastomotic dehiscence (splitting apart of the stitches inside), bleeding or leak at a dehiscence Mortality is low. Recurrence rates are higher than for abdominal repair, 16-30%, but more recent studies give lower recurrence rates. Additional levatorplasty can reduce recurrence rates to 7%.

890:. After reduction of the prolapse, a subcutaneous suture (a stitch under the skin) or other material is placed encircling the anus, which is then made taut to prevent further prolapse. Placing silver wire around the anus first described by Thiersch in 1891. Materials used include nylon, silk, silastic rods, silicone, Marlex mesh, Mersilene mesh, fascia, tendon, and Dacron. This operation does not correct the prolapse itself, it merely supplements the anal sphincter, narrowing the anal canal with the aim of preventing the prolapse from becoming external, meaning it remains in the rectum. This goal is achieved in 54-100% cases. Complications include breakage of the encirclement material, fecal impaction, sepsis, and erosion into the skin or anal canal. Recurrence rates are higher than 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, and who may not tolerate other perineal procedures. 873:

redundant length of bowel. The muscle layer that is left is plicated (folded) and placed as a buttress above the pelvic floor. The edges of the mucosal are then stitched back together. "Mucosal proctectomy" was first discussed by Delorme in 1900, now it is becoming more popular again as it has low morbidity and avoids an abdominal incision, while effectively repairing the prolapse. The procedure is ideally suited to those patients with full-thickness prolapse limited to partial circumference (e.g., anterior wall) or less-extensive prolapse (perineal rectosigmoidectomy may be difficult in this situation). Fecal incontinence is improved following surgery (40%–75% of patients). Post operatively, both mean resting and squeeze pressures were increased. Constipation is improved in 50% of cases, but often urgency and tenesmus are created. Complications, including infection, urinary retention, bleeding,

1681:

a serious medical condition that requires the attention of a medical professional. However, in rosebud pornography, it is performed deliberately. Michelle Lhooq, writing for VICE, argues that rosebudding is an example of producers making 'extreme' content due to the easy availability of free pornography on the internet. She also argues that rosebudding is a way for pornographic actors and actresses to distinguish themselves. Repeated rectal prolapses can cause bowel problems and anal leakage and therefore risk the health of pornographic actors or actresses who participate in them. Lhooq also argues that some who participate in this form of pornography are unaware of the consequences.

391:

thickness external rectal prolapse (a complete rectal prolapse) by the orientation of the folds (furrows) in the prolapsed section. In full thickness rectal prolapse, these folds run circumferential. In mucosal prolapse, these folds are radially. The folds in mucosal prolapse are usually associated with internal hemorrhoids. Furthermore, in rectal prolapse, there is a sulcus present between the prolapsed bowel and the anal verge, whereas in hemorrhoidal disease there is no sulcus. Prolapsed, incarcerated hemorrhoids are extremely painful, whereas as long as a rectal prolapse is not strangulated, it gives little pain and is easy to reduce.

51: 1199:(paradoxical contraction of the pelvic floor during attempted defecation). The operation has been shown to improve rectal sensitivity and decrease rectal volume, the reason thought to create urgency. 90% of patients do not report urgency 12 months after the operation. 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. 602: 764:

external rectal prolapse. The factors that result in a patient progressing from internal intussusception to a full thickness rectal prolapse remain unknown. Defecography studies demonstrated that degrees of internal intussusception are present in 40% of asymptomatic subjects, raising the possibility that it represents a normal variant in some, and may predispose patients to develop symptoms, or exacerbate other problems.

324:(intra-rectal intussusception) is where the intussusception starts in the rectum, does not protrude into the anal canal, but stays within the rectum. (i.e. the intussusceptum originates in the rectum and does not extend into the anal canal. The intussuscipiens includes rectal lumen distal to the intussusceptum only). These are usually intussusceptions that originate in the upper rectum or lower 498: 205:. This infolding is perhaps best visualised as folding a sock inside out, creating "a tube within a tube". Another definition is "where the rectum collapses but does not exit the anus". Many sources differentiate between internal rectal intussusception and mucosal prolapse, implying that the former is a full thickness prolapse of rectal wall. However, a publication by the 238:(rectal internal mucosal prolapse, RIMP) refers to prolapse of the mucosal layer of the rectal wall which does not protrude externally. There is some controversy surrounding this condition as to its relationship with hemorrhoidal disease, or whether it is a separate entity. The term "mucosal hemorrhoidal prolapse" is also used. 1482:, about 7–10 cm from the anus. However, the area may of ulceration may be closer to the anus, deeper inside, or on the lateral or posterior rectal walls. The name "solitary" can be misleading since there may be more than one ulcer present. Furthermore, there is a "preulcerative phase" where there is no ulcer at all. 1664:(MPS) has now been recognized. It includes SRUS, rectal prolapse, proctitis cystica profunda, and inflammatory polyps. It is classified as a chronic benign inflammatory disorder. The unifying feature is varying degrees of rectal prolapse, whether internal intussusception (occult prolapse) or external prolapse. 228:(partial rectal mucosal prolapse) refers to prolapse of the loosening of the submucosal attachments to the muscularis propria of the distal rectummucosal layer of the rectal wall. Most sources define mucosal prolapse as an external, segmental prolapse which is easily confused with prolapsed (3rd or 4th degree) 1680:

Rosebud pornography and prolapse pornography (or rosebudding or rectal prolapse pornography) is an anal sex practice that occurs in some extreme anal pornography wherein a pornographic actor or actress performs a rectal prolapse wherein the walls of the rectum slip out of the anus. Rectal prolapse is

1315:

Mucosal prolapse can be differentiated from a full thickness external rectal prolapse (a complete rectal prolapse) by the orientation of the folds (furrows) in the prolapsed section. In full thickness rectal prolapse, these folds run circumferential. In mucosal prolapse, these folds are radially. The

763:

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

1452:

Overactivity of the anal sphincter during defecation causes the patient to require more effort to expel stool. This pressure is produced by the modified valsalva manovoure (attempted forced exhalation against a closed glottis, resulting in increased abdominal and intra-rectal pressure). Patiest with

735:

The association with uterine prolapse (10-25%) and cystocele (35%) may suggest that there is some underlying abnormality of the pelvic floor that affects multiple pelvic organs. Proximal bilateral pudendal neuropathy has been demonstrated in patients with rectal prolapse who have fecal incontinence.

394:

The prolapse may be obvious, or it may require straining and squatting to produce it. The anus is usually patulous, (loose, open) and has reduced resting and squeeze pressures. Sometimes it is necessary to observe the patient while they strain on a toilet to see the prolapse happen (the perineum can

337:

An Anatomico-Functional Classification of internal rectal intussusception has been described, with the argument that other factors apart from the height of intussusception above the anal canal appear to be important to predict symptomology. The parameters of this classification are anatomic descent,

4552:

Lehur PA, Stuto A, Fantoli M, Villani RD, Queralto M, Lazorthes F, et al. (November 2008). "Outcomes of stapled transanal rectal resection vs. biofeedback for the treatment of outlet obstruction associated with rectal intussusception and rectocele: a multicenter, randomized, controlled trial".

1147:

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. Relapse of the intussusception

390:

Rectal prolapse may be confused easily with prolapsing hemorrhoids. Mucosal prolapse also differs from prolapsing (3rd or 4th degree) hemorrhoids, where there is a segmental prolapse of the hemorrhoidal tissues at the 3, 7 and 11 o'clock positions. Mucosal prolapse can be differentiated from a full

1183:

This operation aims to "remove the anorectal mucosa circumferentially and reinforce the anterior anorectal junction wall with the use of a circular stapler". In contrast to other methods, STARR does not correct the descent of the rectum, it removes the redundant tissue. The technique was developed

872:

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 prolapse is exposed if it is not already present, and the mucosal and submucosal layers are stripped from the

863:

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. The full thickness of the rectal wall is incised at a level just above the dentate

829:

Recovery time following laparoscopic surgery is shorter and less painful than following traditional abdominal surgery. Instead of opening the pelvic cavity with a wide incision (laparotomy), a laparoscope (a thin, lighted tube) and surgical instruments are inserted into the pelvic cavity via small

509:

The true incidence of rectal prolapse is unknown, but it is thought to be uncommon. As most affected people are elderly, the condition is generally under-reported. It may occur at any age, even in children, but there is peak onset in the fourth and seventh decades. Women over 50 are six times more

790:

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, and there have been over 50 different operations described.

743:

Sphincter function in rectal prolapse is almost always reduced. This may be the result of direct sphincter injury by chronic stretching of the prolapsing rectum. Alternatively, the intussuscepting rectum may lead to chronic stimulation of the rectoanal inhibitory reflex (RAIR - contraction of the

580:

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

488:

It 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. There may be denervation of striated musculature on the electromyogram. Increased nerve conduction periods (nerve damage), this may be

998:

Some believe that it 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. The folding section of rectum can cause repeated trauma to the mucosa, and can

777:

Surgery is thought to be the only option to potentially cure a complete rectal prolapse. For people with medical problems that make them unfit for surgery, and those who have minimal symptoms, conservative measures may be beneficial. Dietary adjustments, including increasing dietary fiber may be

630:

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. Other adjacent structures can sometimes be seen in addition to the rectal prolapse. Although a

588:

If the prolapse becomes trapped externally outside the anal sphincters, it may become strangulated and there is a risk of perforation. This may require an urgent surgical operation if the prolapse cannot be manually reduced. Applying granulated sugar on the exposed rectal tissue can reduce the

1791:(termed the intussuscipiens). What results is 3 layers of rectal wall overlaid. From the lumen outwards, the first layer is the proximal wall of the intussusceptum, the middle is the wall of the intussusceptum folded back on itself, and the outer is the distal rectal wall, the intussuscipiens. 838:

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 perineal procedures include perineal rectosigmoidectomy and Delorme repair.

669:

Since most patients with rectal prolapse have a long history of constipation, it is thought that prolonged, excessive and repetitive straining during defecation may predispose to rectal prolapse. Since rectal prolapse itself causes functional obstruction, more straining may result from a small

479:

therapy. Decreased squeeze and resting pressures are usually the findings, and this may predate the development of the prolapse. Resting tone is usually preserved in patients with mucosal prolapse. In patients with reduced resting pressure, levatorplasty may be combined with prolapse repair to

126:

Rectal prolapse is generally more common in elderly women, although it may occur at any age and in either sex. It is very rarely life-threatening, but the symptoms can be debilitating if left untreated. Most external prolapse cases can be treated successfully, often with a surgical procedure.

3807:

Renzi A, Talento P, Giardiello C, Angelone G, Izzo D, Di Sarno G (October 2008). "Stapled trans-anal rectal resection (STARR) by a new dedicated device for the surgical treatment of obstructed defaecation syndrome caused by rectal intussusception and rectocele: early results of a multicenter

505:

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 symptoms can be socially debilitating without treatment, but it is rarely

920:

was first developed and became widespread. Degrees of internal intussusception have been demonstrated in 40% of asymptomatic subjects, raising the possibility that it represents a normal variant in some, and may predispose patients to develop symptoms, or exacerbate other problems.

1006:

Others argue that the majority of patients appear to have rectal intussusception as a consequence of obstructed defecation rather than a cause, possibly related to excessive straining in patients with obstructed defecation. Patients with other causes of obstructed defecation

744:

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.

4198:

Gosselink MP, Adusumilli S, Harmston C, Wijffels NA, Jones OM, Cunningham C, Lindsey I (December 2013). "Impact of slow transit constipation on the outcome of laparoscopic ventral rectopexy for obstructed defaecation associated with high grade internal rectal prolapse".

3943:

Adusumilli S, Gosselink MP, Fourie S, Curran K, Jones OM, Cunningham C, Lindsey I (November 2013). "Does the presence of a high grade internal rectal prolapse affect the outcome of pelvic floor retraining in patients with faecal incontinence or obstructed defaecation?".

258:

Rectal prolapse and internal rectal intussusception has been classified according to the size of the prolapsed section of rectum, a function of rectal mobility from the sacrum and infolding of the rectum. This classification also takes into account sphincter relaxation:

103:

and are visible outside the body. 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.

1464:(which should normally relax during defecation). The increased pressure forces the anterior rectal lining against the contracted puborectalis and frequently the lining prolapses into the anal canal during straining and then returns to its normal position afterwards. 3067: 381:

Patients may have associated gynecological conditions which may require multidisciplinary management. History of constipation is important because some of the operations may worsen constipation. Fecal incontinence may also influence the choice of management.

414:(swelling) of the distal rectal mucosa, and in 10-15% of cases there may be a solitary rectal ulcer on the anterior rectal wall. Localized inflammation or ulceration can be biopsied and may lead to a diagnosis of SRUS or colitis cystica profunda. Rarely, a 877:

dehiscence (opening of the stitched edges inside), stricture (narrowing of the gut lumen), diarrhea, and fecal impaction occur in 6-32% of cases. Mortality occurs in 0–2.5% cases. There is a higher recurrence rate than abdominal approaches (7-26% cases).

1243:

Symptom severity increases with the size of the prolapse, and whether it spontaneously reduces after defecation, requires manual reduction by the patient, or becomes irreducible. The symptoms are identical to advanced hemorrhoidal disease, and include:

807:. Procedures for rectal prolapse may involve fixation of the bowel (rectopexy), or resection (a portion removed), or both. Trans-anal (endo-anal) procedures are also described where access to the internal rectum is gained through the anus itself. 248:

of the rectal lining caused by repeated frictional damage as the internal intussusception is forced into the anal canal during straining. SRUS can be considered a consequence of internal intussusception, which can be demonstrated in 94% of cases.

5969: 5954: 1221:. It is different to an internal intussusception (occult prolapse) or a complete rectal prolapse (external prolapse, procidentia) because these conditions involve the full thickness of the rectal wall, rather than only the mucosa (lining). 1035:

is by telescoping of the intussusceptum, occluding the rectal lumen during attempted defecation. One study analysed resected rectal wall specimens in patients with obstructed defecation associated with rectal intussusception undergoing

521:

35% of women with rectal prolapse have never had children, suggesting that pregnancy and labor are not significant factors. Anatomical differences such as the wider pelvic outlet in females may explain the skewed gender distribution.

5515:

Levine DS, Surawicz CM, Ajer TN, Dean PJ, Rubin CE (November 1988). "Diffuse excess mucosal collagen in rectal biopsies facilitates differential diagnosis of solitary rectal ulcer syndrome from other inflammatory bowel diseases".

3717:

Bassotti G, Villanacci V, Bellomi A, Fante R, Cadei M, Vicenzi L, et al. (March 2012). "An assessment of enteric nervous system and estroprogestinic receptors in obstructed defecation associated with rectal intussusception".

434:

This investigation is used to diagnose internal intussusception, or demonstrate a suspected external prolapse that could not be produced during the examination. It is usually not necessary with obvious external rectal prolapse.

309:

The most widely used classification of internal rectal prolapse is according to the height on the rectal/sigmoid wall from which they originate and by whether the intussusceptum remains within the rectum or extends into the

751:

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.

334:(intra-anal intussusception) is where the intussusception starts in the rectum and protrudes into the anal canal (i.e. the intussusceptum originates in the rectum, and the intussuscipiens includes part of the anal canal) 810:

Abdominal procedures are associated with lower risk of postoperative recurrence of the prolapse, compared with perineal procedures (6.1% vs 16.3% in patients who are younger than 65 years of age at the time of surgery).

649:

to show that rectal prolapse begins as a circumferential intussusception of the rectum, which slowly increases over time. The leading edge of the intussusceptum may be located at 6–8 cm or at 15–18 cm from the

221:

layer attachments, resulting in the separated portion of rectal lining "sliding" down. This may signify that authors use the terms internal rectal prolapse and internal mucosal prolapse to describe the same phenomena.

3320:

Portier G, Kirzin S, Cabarrot P, Queralto M, Lazorthes F (August 2011). "The effect of abdominal ventral rectopexy on faecal incontinence and constipation in patients with internal intra-anal rectal intussusception".

755:

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

4108:

Gosselink MP, Adusumilli S, Gorissen KJ, Fourie S, Tuynman JB, Jones OM, et al. (December 2013). "Laparoscopic ventral rectopexy for fecal incontinence associated with high-grade internal rectal prolapse".

191:(rectal procidentia, full thickness rectal prolapse, overt rectal prolapse) is a full thickness, circumferential, true intussusception of the rectal wall which protrudes from the anus and is visible externally. 1030:

combined with internal intussusception (as 94% of SRUS patients have) were shown to have altered rectal wall biomechanics compared to patients with internal intussusception alone. The presumed mechanism of the

794:

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 an incision around the anus and

470:

This investigation objectively documents the functional status of the sphincters. However, the clinical significance of the findings are disputed by some. It may be used to assess for pelvic floor dyssenergia,

1485:

Pathological specimens of sections of rectal wall taken from SRUS patients show thickening and replacement of muscle with fibrous tissue and excess collagen. Rarely, SRUS can present as polyps in the rectum.

2171:

Gouvas, N; Georgiou, PA; Agalianos, C; Tan, E; Tekkis, P; Dervenis, C; Xynos, E (February 2015). "Ventral colporectopexy for overt rectal prolapse and obstructed defaecation syndrome: a systematic review".

255:(MPS) is recognized by some. It includes solitary rectal ulcer syndrome, rectal prolapse, proctitis cystica profunda, and inflammatory polyps. It is classified as a chronic benign inflammatory disorder. 5480:

Blanco F, Frasson M, Flor-Lorente B, Minguez M, Esclapez P, García-Granero E (November 2011). "Solitary rectal ulcer: ultrasonographic and magnetic resonance imaging patterns mimicking rectal cancer".

4726:

Halligan S, Nicholls RJ, Bartram CI (January 1995). "Evacuation proctography in patients with solitary rectal ulcer syndrome: anatomic abnormalities and frequency of impaired emptying and prolapse".

510:

likely to develop rectal prolapse than men. It is rare in men over 45 and in women under 20. When males are affected, they tend to be young and report significant bowel function symptoms, especially

1507:

in the muscle layers of the gut lining, and it can occur anywhere along the gastrointestinal tract. When it occurs in the rectum, some believe to be an interchangeable diagnosis with SRUS since the

6913: 1133:), then biofeedback retraining is indicated. Some researchers advise that internal intussusception be managed conservatively, compared to external rectal prolapse which usually requires surgery. 4334:

Dodi G, Pietroletti R, Milito G, Binda G, Pescatori M (October 2003). "Bleeding, incontinence, pain and constipation after STARR transanal double stapling rectotomy for obstructed defecation".

1538:

SRUS is commonly misdiagnosed, and the diagnosis is not made for 5–7 years. Clinicians may not be familiar with the condition, and treat for Inflammatory bowel disease, or simple constipation.

232:(piles). However, both internal mucosal prolapse (see below) and circumferential mucosal prolapse are described by some. Others do not consider mucosal prolapse a true form of rectal prolapse. 150:

The different kinds of rectal prolapse can be difficult to grasp, as different definitions are used and some recognize some subtypes and others do not. Essentially, rectal prolapses may be:

5084:

Levine DS (January 1987). ""Solitary" rectal ulcer syndrome. Are "solitary" rectal ulcer syndrome and "localized" colitis cystica profunda analogous syndromes caused by rectal prolapse?".

462:

if there is a history of severe constipation. Continent prolapse patients with slow transit constipation, and who are fit for surgery may benefit from subtotal colectomy with rectopexy.

1471:), combined with repeated frictional trauma from the prolapsing lining, and exposure to increased pressure are thought to cause ulceration. Trauma from hard stools may also contribute. 1489:

SRUS is therefore associated and with internal, and more rarely, external rectal prolapse. Some believe that SRUS represents a spectrum of different diseases with different causes.

1649:

Surgery may be considered, but only if non surgical treatment has failed and the symptoms are severe enough to warrant the intervention. Improvement with surgery is about 55-60%.

995:

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.

5602:

van den Brandt-Grädel V, Huibregtse K, Tytgat GN (November 1984). "Treatment of solitary rectal ulcer syndrome with high-fiber diet and abstention of straining at defecation".

4155:

Boons P, Collinson R, Cunningham C, Lindsey I (June 2010). "Laparoscopic ventral rectopexy for external rectal prolapse improves constipation and avoids de novo constipation".

6091: 4629:

Ertem D, Acar Y, Karaa EK, Pehlivanoglu E (December 2002). "A rare and often unrecognized cause of hematochezia and tenesmus in childhood: solitary rectal ulcer syndrome".

3364:

Johansson C, Ihre T, Ahlbäck SO (December 1985). "Disturbances in the defecation mechanism with special reference to intussusception of the rectum (internal procidentia)".

855:. Alternatively, perineal procedures may be selected to reduce risk of nerve damage, for example in young male patients for whom sexual dysfunction may be a major concern. 136: 2145: 4017:

Felt-Bersma RJ, Tiersma ES, Stella MT, Cuesta MA (September 2008). "Rectal prolapse, rectal intussusception, rectocele, solitary rectal ulcer syndrome, and enterocele".

3991: 1364:. SRUS can therefore be considered to be a consequence of internal intussusception (a sub type of rectal prolapse), which can be demonstrated in 94% of cases. It may be 4377:

Bassi R, Rademacher J, Savoia A (December 2006). "Rectovaginal fistula after STARR procedure complicated by haematoma of the posterior vaginal wall: report of a case".

6595: 1453:

SRUS were shown to have higher intra-rectal pressures when straining than healthy controls. SRUS is also associated with prolonged and incomplete evacuation of stool.

736:

This finding was shown to be absent in healthy subjects, and may be the cause of denervation-related atrophy of the external anal sphincter. Some authors suggest that

1172:

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

1169:) in patients with rectal intussusception. The operation has been shown to have low recurrence rate (around 5%). It also improves obstructed defecation symptoms. 4242:

Samaranayake CB, Luo C, Plank AW, Merrie AE, Plank LD, Bissett IP (June 2010). "Systematic review on ventral rectopexy for rectal prolapse and intussusception".

987:

It has been observed that intussusceptions of thickness ≥3 mm, and those that appear to cause obstruction to rectal evacuation may give clinical symptoms.

206: 2617:

Guanziroli E, Veraldi S, Guttadauro A, Rizzitelli G, Frassani S (Aug 1, 2011). "Persistent perianal dermatitis associated with mucosal hemorrhoidal prolapse".

608:

showing a rectal wall with changes seen in rectal prolapse. There is a marked increase of fibrous tissue in the submucosa and fibrous tissue +/- smooth muscle

525:

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

1603:

have all been used to diagnose and study SRUS. Some recommend biopsy as essential for diagnosis since ulcerations may not always be present, and others state

6190: 1467:

The repeated trapping of the lining can cause the tissue to become swollen and congested. Ulceration is thought to be caused by resulting poor blood supply (

638:, originating in the cul de sac of Douglas, may protrude from the anus (via the anterior rectal wall), this is a different situation from rectal prolapse. 6229: 700:

Some authors question whether these abnormalities are the cause, or secondary to the prolapse. Other predisposing factors/associated conditions include:

298: 4420:

Sciaudone G, Di Stazio C, Guadagni I, Selvaggi F (March 2008). "Rectal diverticulum: a new complication of STARR procedure for obstructed defecation".

3761:

Abendstein B, Petros PE, Richardson PA, Goeschen K, Dodero D (May 2008). "The surgical anatomy of rectocele and anterior rectal wall intussusception".

3674:

Dvorkin LS, Gladman MA, Scott SM, Williams NS, Lunniss PJ (July 2005). "Rectal intussusception: a study of rectal biomechanics and visceroperception".

976:

intussusceptions commonly give more severe symptoms of straining, incomplete evacuation, need for digital evacuation of stool, need for support of the

244:(SRUS, solitary rectal ulcer, SRU) occurs with internal rectal intussusception and is part of the spectrum of rectal prolapse conditions. It describes 3856:"Stapled transanal rectal resection for the surgical treatment of obstructed defecation syndrome associated with rectocele and rectal intussusception" 422:. Full length colonoscopy is usually carried out in adults prior to any surgical intervention. These investigations may be used with contrast media ( 418:(tumour) may form on the leading edge of the intussusceptum. In addition, patients are frequently elderly and therefore have increased incidence of 283:

Rectal internal mucosal prolapse has been graded according to the level of descent of the intussusceptum, which was predictive of symptom severity:

2795:

Pescatori M, Quondamcarlo C (November 1999). "A new grading of rectal internal mucosal prolapse and its correlation with diagnosis and treatment".

6084: 1093:

or dynamic MRI defecography can demonstrate the abnormal folding of the rectal wall. Some have advocated the use of anorectal physiology testing (

684:

loss of the normal horizontal position of the rectum with lengthening (redundant rectosigmoid) and downward displacement of the sigmoid and rectum

623:

The precise cause is unknown, and has been much debated. In 1912 Moschcowitz proposed that rectal prolapse was a sliding hernia through a pelvic

1136:

As with external rectal prolapse, there are a great many different surgical interventions described. Generally, a section of rectal wall can be

1162:

This procedure aims to " the descent of the posterior and middle pelvic compartments combined with reinforcement of the rectovaginal septum".

6457: 2914: 2884: 2474: 2414: 2314: 1884: 3553:

Christiansen J, Hesselfeldt P, Sørensen M (May 1995). "Treatment of internal rectal intussusception in patients with chronic constipation".

740:

damage is the cause for pelvic floor and anal sphincter weakening, and may be the underlying cause of a spectrum of pelvic floor disorders.

819:

The abdominal approach carries a small risk of impotence in males (e.g. 1-2% in abdominal rectopexy). Abdominal operations may be open or

3908:

Goei R, Baeten C (January 1990). "Rectal intussusception and rectal prolapse: detection and postoperative evaluation with defecography".

1191:

Complications, sometimes serious, have been reported following STARR, but the procedure is now considered safe and effective. STARR is

5984: 5453:

Lokuhetty D, de Silva MV, Mudduwa L (December 1998). "Solitary rectal ulcer syndrome (SRUS) masquerading as a carcinomatous stricture".

5054:

Vora IM, Sharma J, Joshi AS (April 1992). "Solitary rectal ulcer syndrome and colitis cystica profunda--a clinico-pathological review".

1037: 395:

be seen with a mirror or by placing an endoscope in the bowl of the toilet). A phosphate enema may need to be used to induce straining.

4470:"Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures" 6670: 6077: 3631:

Dvorkin LS, Knowles CH, Scott SM, Williams NS, Lunniss PJ (April 2005). "Rectal intussusception: characterization of symptomatology".

3148:

Mellgren A, Schultz I, Johansson C, Dolk A (July 1997). "Internal rectal intussusception seldom develops into total rectal prolapse".

1761: 1716:

procidentia has a similar meaning to prolapse, referring to "a sinking or prolapse of an organ or part". It is derived from the Latin

1672:

Rectal prolapse affects less than 0.5% of the general population. It affects women more commonly, with a female to male ratio of 9:1.

1144:, or a combination of both methods. Surgery for internal rectal prolapse can be via the abdominal approach or the transanal approach. 7342: 7189: 1735:(infolding), especially referring to "the slipping of a length of intestine into an adjacent portion". It is derived from the Latin 1689:

Prolapse refers to "the falling down or slipping of a body part from its usual position or relations". It is derived from the Latin

1188:. Since, specialized circular staplers have been developed for use in external rectal prolapse and internal rectal intussusception. 670:

prolapse, with increasing damage to the anatomy. This excessive straining may be due to predisposing pelvic floor dysfunction (e.g.

2719:"The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases" 2405:

Wolff BG, Fleshman JW, Beck DE, Pemberton JH, Wexner SD, Church JM, Garcia-Aguilar J, Roberts PL, Saclarides TJ, Stamos MJ (2007).

5893: 4599:

Mackle EJ, Parks TG (October 1986). "The pathogenesis and pathophysiology of rectal prolapse and solitary rectal ulcer syndrome".

799:(the area between the genitals and the anus). Abdominal approach (trans-abdominal approach) involves the surgeon cutting into the 7087: 3510:

Christiansen J, Zhu BW, Rasmussen OO, Sørensen M (November 1992). "Internal rectal intussusception: results of surgical repair".

2501:

Gupta PJ (2006). "Treatment of rectal mucosal prolapse with radiofrequency coagulation and plication--a new surgical technique".

1324: 5792:

Vaizey CJ, van den Bogaerde JB, Emmanuel AV, Talbot IC, Nicholls RJ, Kamm MA (December 1998). "Solitary rectal ulcer syndrome".

585:

maneuvers). A chronically prolapsed rectal tissue may undergo pathological changes such as thickening, ulceration and bleeding.

7228: 6840: 6823: 6328: 6323: 6200: 3588:

Ihre T, Seligson U (Jul–Aug 1975). "Intussusception of the rectum-internal procidentia: treatment and results in 90 patients".

2149: 50: 6353: 3995: 1064:

The following conditions occur more commonly in patients with internal rectal intussusception than in the general population:

135: 7082: 7038: 6932: 6754: 1994: 1336: 1085:

Unlike external rectal prolapse, internal rectal intussusception is not visible externally, but it may still be diagnosed by

1073: 1027: 1000: 839:

Elderly, or other medically high-risk patients are usually treated by perineal procedures, as they can be performed under a

7293: 1019:

are coexistent in 11% of patients with internal intussusception. Symptoms of internal intussusception overlap with those of

2566:

Gaj F, Trecca A (July 2005). "Hemorrhoids and rectal internal mucosal prolapse: one or two conditions? A national survey".

970:, apart from mild obstructed defecation. "interrupted defaecation" in the morning is thought by some to be characteristic. 7139: 1296:

Mucosal prolapse occurs when the results from loosening of the submucosal attachments (between the mucosal layer and the

197:(occult rectal prolapse, internal procidentia) can be defined as a funnel shaped infolding of the upper rectal (or lower 7048: 6567: 6175: 1784: 1776: 1301: 6262: 7379: 1526:

Complications are uncommon, but include massive rectal bleeding, ulceration into the prostate gland or formation of a

6158: 901:(rectal intussusception, internal intussusception, internal rectal prolapse, occult rectal prolapse, internal rectal 69:. Note circumferential arrangement of folds in full thickness prolapse compared to radial folds in mucosal prolapse. 6628: 6557: 5011:

Kang YS, Kamm MA, Nicholls RJ (1995). "Solitary rectal ulcer and complete rectal prolapse: one condition or two?".

1086: 2768:

Fleshman JW, Kodner IJ, Fry RD (December 1989). "Internal intussusception of the rectum: a changing perspective".

1210:(mucosal prolapse, anal mucosal prolapse) is a sub-type of rectal prolapse, and refers to abnormal descent of the 6901: 6857: 6810: 6616: 6234: 5205:"Acute hemorrhagic rectal ulcer syndrome: a new clinical entity? Report of 19 cases and review of the literature" 4517:

Boffi F (June 2008). "Retained staples causing rectal bleeding and severe proctalgia after the STARR procedure".

2444: 1623: 6927: 2174:

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

1356:. This increased pressure causes the anterior portion of the rectal lining to be forced into the anal canal (an 7384: 7247: 6562: 6520: 6333: 6208: 6195: 6136: 5995: 5647:"Behavioural therapy (biofeedback) for solitary rectal ulcer syndrome improves symptoms and mucosal blood flow" 662:

that this condition is essentially a full-thickness rectal intussusception, beginning about 3 inches above the

6165: 1441:

The condition is thought to be uncommon. It usually occurs in young adults, but children can be affected too.

475:

is a contraindication for certain surgeries, e.g. STARR), and these patients may benefit from post-operative

455: 7172: 6949: 6690: 6482: 6141: 338:

diameter of intussuscepted bowel, associated rectal hyposensitivity and associated delayed colonic transit:

501:

A severe example of complete (external) rectal prolapse. Note circumferential arrangement of mucosal folds.

107:

Rectal prolapse may occur without any symptoms, but depending upon the nature of the prolapse there may be

7252: 6976: 6959: 6369: 6343: 6219: 6170: 6131: 6109: 6101: 1772:, which can sometimes be a medical emergency. Rectal intussusception by contrast is not life-threatening. 1041: 398:

The perianal skin may be macerated (softening and whitening of skin that is kept constantly wet) and show

5119:

Beck DE (June 2002). "Surgical Therapy for Colitis Cystica Profunda and Solitary Rectal Ulcer Syndrome".

3249: 681:

poor posterior rectal fixation, resulting in loss of posterior fixation of the rectum to the sacral curve

7184: 7092: 7053: 6981: 1805: 1381: 1232: 1090: 1032: 1008: 943: 917: 671: 655: 559: 511: 127:

Internal prolapses are traditionally harder to treat and surgery may not be suitable for many patients.

120: 7103: 6284: 3273:"Abdominal versus perineal approach for external rectal prolapse: systematic review with meta-analysis" 1195:

in patients with weak sphincters (fecal incontinence and urgency are a possible complication) and with

3069:

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease

7223: 7167: 6988: 6884: 6467: 6462: 6296: 6214: 6180: 3044: 848: 820: 581:

that is difficult to keep inside, and occurs with walking, prolonged standing, coughing or sneezing (

1377: 830:

incisions. Rectopexy and anterior resection have been performed laparoscopically with good results.

7317: 7127: 7020: 7003: 6964: 6937: 6889: 6732: 6709: 6702: 6651: 6623: 6545: 6540: 6535: 6452: 5973: 1639: 1596: 1137: 1094: 840: 659: 297: 3463:"Rectal intussusception in symptomatic patients is different from that in asymptomatic volunteers" 3271:

Pellino G, Fuschillo G, Simillis C, Selvaggi L, Signoriello G, Vinci D, et al. (March 2022).

2544: 7329: 7194: 7177: 7162: 7149: 7132: 6998: 6525: 6497: 6257: 6153: 6118: 5817: 5774: 5627: 5584: 5541: 5337: 5144: 5036: 4578: 4445: 4402: 4359: 4267: 4224: 4180: 4134: 3969: 3833: 3786: 3743: 3699: 3656: 3613: 3535: 3492: 3389: 3346: 3173: 3093: 2820: 2599: 2526: 1800: 1429: 1297: 1122: 1049: 1045: 981: 852: 748: 541: 116: 6633: 6431: 4061:"Controversy in the treatment of symptomatic internal rectal prolapse: suspension or resection?" 3063: 1148:

after treatment is a problem. Two of the most commonly employed procedures are discussed below.

711:

previous surgery (30-50% of females with the condition underwent previous gynecological surgery)

1615:

Although SRUS is not a medically serious disease, it can be the cause of significantly reduced

1508: 7307: 7288: 6661: 6035: 6006: 5914: 5869: 5809: 5766: 5725: 5676: 5619: 5576: 5533: 5497: 5462: 5435: 5386: 5329: 5285: 5254:"Massive rectal bleeding: rare presentation of circumferential solitary rectal ulcer syndrome" 5234: 5185: 5136: 5101: 5063: 5028: 4993: 4942: 4893: 4844: 4795: 4743: 4705: 4656: 4608: 4570: 4534: 4499: 4437: 4394: 4351: 4316: 4259: 4216: 4172: 4126: 4090: 4034: 3961: 3925: 3887: 3825: 3778: 3735: 3691: 3648: 3605: 3570: 3527: 3484: 3443: 3381: 3338: 3302: 3225: 3165: 3081: 3026: 2990: 2963: 2910: 2880: 2812: 2777: 2750: 2690: 2644: 2591: 2518: 2470: 2410: 2310: 2259: 2189: 1880: 1857: 1449:

The essential cause of SRUS is thought to be related to too much straining during defecation.

1157: 887: 419: 218: 74: 5559:

Bishop PR, Nowicki MJ (June 2002). "Nonsurgical Therapy for Solitary Rectal Ulcer Syndrome".

5164:"A benign rectal ulcer penetrating into the prostate--diagnosis by prostate-specific antigen" 4864:"Pathology of the rectal wall in solitary rectal ulcer syndrome and complete rectal prolapse" 2306: 1749: 1175:

The advantage of the laparoscopic approach is decreased healing time and less complications.

7354: 7274: 7269: 7259: 7121: 6993: 6921: 6739: 6646: 6641: 6571: 6530: 6338: 6303: 5859: 5851: 5801: 5756: 5715: 5707: 5696:"Prospective evaluation of the treatment of solitary rectal ulcer syndrome with biofeedback" 5666: 5658: 5611: 5568: 5525: 5489: 5425: 5417: 5376: 5368: 5319: 5275: 5265: 5224: 5216: 5175: 5128: 5093: 5020: 4983: 4973: 4932: 4924: 4883: 4875: 4834: 4826: 4785: 4777: 4735: 4695: 4687: 4646: 4638: 4562: 4526: 4489: 4481: 4429: 4386: 4343: 4306: 4298: 4251: 4208: 4164: 4118: 4080: 4072: 4026: 3953: 3917: 3877: 3867: 3817: 3770: 3727: 3683: 3640: 3597: 3562: 3519: 3474: 3433: 3425: 3373: 3330: 3292: 3284: 3215: 3207: 3157: 3073: 2953: 2943: 2804: 2740: 2730: 2680: 2634: 2626: 2583: 2575: 2510: 2298: 2249: 2241: 2181: 1847: 1810: 1725: 1600: 1497: 1403: 1260: 1192: 1141: 905:

and rectal invagination) is a medical condition defined as a funnel shaped infolding of the

844: 778:

beneficial to reduce constipation, and thereby reduce straining. A bulk forming agent (e.g.

632: 545: 108: 66: 2017: 601: 7312: 7242: 7108: 7043: 7008: 6879: 6680: 6582: 6501: 6492: 6442: 6382: 6267: 6244: 3105: 2906: 2901: 1780: 1769: 1765: 1754: 1704: 1616: 1414: 1408: 1373: 1254: 1105:

Nonsurgical measures to treat internal intussusception include pelvic floor retraining, a

956: 947: 757: 568: 555: 459: 362:

Type 2M Narrowed internal lumen with associated rectal hyposensitivity or early megarectum

112: 79: 6069: 4285:

Lenisa L, Schwandner O, Stuto A, Jayne D, Pigot F, Tuech JJ, et al. (October 2009).

1327:(examination under anesthesia) of anorectum and banding of the mucosa with rubber bands. 7349: 7264: 6818: 6791: 6656: 6591: 6587: 6477: 6447: 5864: 5839: 5720: 5695: 5671: 5646: 5430: 5405: 5381: 5356: 5280: 5253: 5229: 5204: 4988: 4961: 4937: 4912: 4888: 4863: 4839: 4814: 4790: 4765: 4700: 4675: 4494: 4469: 4311: 4286: 4085: 4060: 3882: 3855: 3438: 3413: 3297: 3272: 3220: 3195: 3072:. Vol. 187. Global Initiative for Chronic Obstructive Lung Disease. pp. 1–7. 2958: 2931: 2745: 2718: 2254: 2229: 1852: 1835: 1619:

for patients. It is difficult to treat, and treatment is aimed at minimizing symptoms.

1574: 1515: 1479: 1140:(removed), or the rectum can be fixed (rectopexy) to its original position against the 737: 613: 5978: 5180: 5163: 2932:"Acute scrotum as a complication of Thiersch operation for rectal prolapse in a child" 1699: 7373: 7282: 7235: 7028: 6971: 6954: 6866: 6611: 6438: 6313: 6279: 6224: 5805: 5761: 5744: 5308:"Clinical presentation of and outcome for solitary rectal ulcer syndrome in children" 5097: 4911:

Brosens LA, Montgomery EA, Bhagavan BS, Offerhaus GJ, Giardiello FM (November 2009).

4582: 4302: 4271: 4255: 4184: 4168: 3731: 3687: 3334: 3119: 2685: 2668: 1627: 1584: 1553: 1248: 1166: 1126: 1114: 937: 804: 325: 198: 5778: 5588: 5341: 5148: 5040: 4962:"Solitary rectal ulcer syndrome presenting as polypoid mass lesions in a young girl" 4766:"Transrectal ultrasound study of the pathogenesis of solitary rectal ulcer syndrome" 4449: 4406: 4228: 3973: 3921: 3837: 3790: 3703: 3660: 3617: 3496: 3393: 3350: 2824: 2667:

Nonaka T, Inamori M, Kessoku T, Ogawa Y, Yanagisawa S, Shiba T, et al. (2011).

2603: 2530: 1307:. The section of prolapsed rectal mucosa can become ulcerated, leading to bleeding. 7157: 7069: 6942: 6845: 6796: 6781: 6776: 6772: 6685: 6510: 6426: 6318: 6308: 6274: 6046: 5821: 5631: 5545: 4363: 4138: 3747: 3539: 3177: 2669:"A case of rectal cancer arising from long-standing prolapsed mucosa of the rectum" 2299: 2245: 1732: 1604: 1580: 1461: 1420: 1365: 1290: 1270: 967: 930: 663: 646: 642: 551: 515: 436: 423: 315: 17: 3461:

Dvorkin LS, Gladman MA, Epstein J, Scott SM, Williams NS, Lunniss PJ (July 2005).

760:, creating a blockage that straining, anismus and colonic dysmotility exacerbate. 617: 6000: 5493: 5324: 5307: 4122: 1834:

Hammond K, Beck DE, Margolin DA, Whitlow CB, Timmcke AE, Hicks TC (Spring 2007).

1360:). The lining of the rectum is repeatedly damaged by this friction, resulting in 1003:. However, internal intussusception rarely progress to external rectal prolapse. 7337: 7099: 7077: 6908: 6828: 6472: 6373: 6126: 6030: 1721: 1643: 1511:

features of the conditions overlap. Indeed, CCP is managed identically to SRUS.

1369: 1265: 1225: 902: 874: 705: 609: 476: 399: 6011: 3077: 2514: 7113: 6786: 6764: 6409: 6348: 6057: 6052: 5963: 5572: 5220: 5132: 4739: 4566: 4530: 4485: 4433: 4390: 4347: 4076: 4030: 3821: 3774: 3644: 3566: 3288: 2579: 1588: 1397: 1361: 1353: 1349: 1286: 1185: 1016: 910: 651: 605: 444: 311: 245: 229: 202: 3007:

Essential Revision Notes in Surgery for Medical Students By Irfan Halim; p139

1541:

The thickened lining or ulceration can also be mistaken for types of cancer.

157:(complete), where all the layers of the rectal wall prolapse, or involve the 7063: 7033: 6896: 6874: 6727: 6578: 6552: 6414: 6404: 6291: 6252: 6185: 6041: 5662: 5270: 4928: 2735: 2630: 1631: 1559: 1316:

folds in mucosal prolapse are usually associated with internal hemorrhoids.

1224:

Mucosal prolapse is a different condition to prolapsing (3rd or 4th degree)

1068: 1053: 1020: 497: 440: 415: 314:. The height of intussusception from the anal canal is usually estimated by 214: 96: 5873: 5855: 5680: 5580: 5501: 5466: 5439: 5421: 5390: 5333: 5289: 5238: 5203:

Tseng CA, Chen LT, Tsai KB, Su YC, Wu DC, Jan CM, et al. (June 2004).

5140: 4997: 4978: 4946: 4781: 4691: 4660: 4642: 4574: 4538: 4503: 4441: 4398: 4355: 4320: 4263: 4220: 4176: 4130: 4094: 4038: 3965: 3891: 3829: 3782: 3739: 3695: 3652: 3488: 3447: 3429: 3342: 3306: 3211: 3085: 3030: 2967: 2948: 2816: 2754: 2694: 2648: 2595: 2522: 2263: 2193: 1861: 1713:

can refer to many different medical conditions other than rectal prolapse.

1530:. Very rarely, cancer can arise on the section of prolapsed rectal lining. 5894:"Extreme Anal Porn's Shitty Consequences | VICE | United States" 5813: 5770: 5745:"Long-term clinical outcome of surgery for solitary rectal ulcer syndrome" 5729: 5623: 5537: 5189: 5105: 5067: 5032: 4897: 4848: 4830: 4799: 4747: 4709: 4612: 3929: 3872: 3609: 3574: 3531: 3385: 3229: 3194:

Shorvon PJ, McHugh S, Diamant NE, Somers S, Stevenson GW (December 1989).

3169: 2994: 2808: 2781: 678:

Abnormally low descent of the peritoneum covering the anterior rectal wall

6697: 6675: 6387: 5711: 4879: 4059:

Festen S, van Geloven AA, D'Hoore A, Lindsey I, Gerhards MF (June 2011).

2875:

Yamada T, Alpers DH, Kalloo AN, Kaplowitz N, Owyang C, Powell DW (2009).

1710: 1635: 1527: 1475: 1468: 1424: 1110: 1106: 977: 796: 779: 722: 718: 582: 573: 287:

first degree prolapse is detectable below the anorectal ring on straining

5946: 4764:

Van Outryve MJ, Pelckmans PA, Fierens H, Van Maercke YM (October 1993).

4651: 2587: 2139: 2137: 2135: 2133: 2131: 2129: 2127: 2125: 2123: 2121: 2119: 2117: 2115: 2113: 2111: 2109: 2107: 2105: 2103: 2101: 2099: 2097: 2095: 2093: 2091: 2089: 2087: 2085: 2083: 2081: 2079: 2077: 2075: 2073: 2071: 2069: 2067: 2065: 2063: 2061: 2059: 2057: 2055: 6749: 6515: 6419: 6391: 5615: 5529: 5024: 4212: 3957: 3601: 3523: 3377: 3161: 2639: 2185: 2053: 2051: 2049: 2047: 2045: 2043: 2041: 2039: 2037: 2035: 1815: 1568: 1457: 1196: 1130: 1012: 800: 472: 264: 5372: 2879:(5th ed.). Chichester, West Sussex: Blackwell Pub. p. 1725. 2717:

Abid S, Khawaja A, Bhimani SA, Ahmad Z, Hamid S, Jafri W (June 2012).

1988: 1986: 1984: 1982: 1980: 1978: 1976: 1974: 1972: 1970: 1968: 1966: 1964: 1962: 1960: 1958: 1956: 1954: 1952: 1950: 1948: 1946: 1944: 1942: 1940: 1938: 1936: 1934: 1932: 1930: 1928: 1926: 1924: 1922: 1920: 1918: 1916: 7215: 6833: 6719: 5958: 4287:"STARR with Contour Transtar: prospective multicentre European study" 3479: 3462: 1914: 1912: 1910: 1908: 1906: 1904: 1902: 1900: 1898: 1896: 1788: 1592: 1548: 1345: 1304: 1214: 1211: 1118: 906: 635: 624: 210: 92: 5404:

Amaechi I, Papagrigoriadis S, Hizbullah S, Ryan SM (November 2010).

2445:"Internal Rectal Intussusception [Internal Rectal Prolapse]" 1728:, but rectal procidentia can also be a synonym for rectal prolapse. 1129:

or more severe FI), or paradoxical contraction of the pelvic floor (

518:). When children are affected, they are usually under the age of 3. 6665: 6395: 5840:"Evaluation, Diagnosis, and Medical Management of Rectal Prolapse" 4674:

Womack NR, Williams NS, Holmfield JH, Morrison JF (October 1987).

2981:

Turell R (April 1974). "Sexual problems as seen by proctologist".

1504: 1501: 600: 590: 496: 411: 296: 5406:"Solitary rectal ulcer syndrome mimicking rectal neoplasm on MRI" 2230:"Surgery for complete (full-thickness) rectal prolapse in adults" 1500:

in the rectum. Cystica profunda is characterized by formation of

1089:, while the patient strains as if to defecate. Imaging such as a 704:

pregnancy (although 35% of women who develop rectal prolapse are

5989: 4676:"Pressure and prolapse--the cause of solitary rectal ulceration" 3763:

International Urogynecology Journal and Pelvic Floor Dysfunction

1218: 1015:

also tend to have higher incidence of internal intussusception.

177:, where the whole circumference of the rectal wall prolapse, or 100: 6073: 1492:

Another condition associated with internal intussusception is

181:

if only parts of the circumference of the rectal wall prolapse

167:

if they protrude from the anus and are visible externally, or

5743:

Sitzler PJ, Kamm MA, Nicholls RJ, McKee RF (September 1998).

3196:"Defecography in normal volunteers: results and implications" 1496:(also known as CCP, or proctitis cystica profunda), which is 2438: 2436: 2434: 2432: 2430: 2428: 2426: 1331:

Solitary rectal ulcer syndrome and colitis cystica profunda

916:

This phenomenon was first described in the late 1960s when

5645:

Jarrett ME, Emmanuel AV, Vaizey CJ, Kamm MA (March 2004).

4913:"Mucosal prolapse syndrome presenting as rectal polyposis" 3243: 3241: 3239: 1646:

retraining to coordinate pelvic floor during defecation.

209:

stated that internal rectal intussusception involved the

1760:

Rectal intussusception is not to be confused with other

1544:

The differential diagnosis of SRUS (and CCP) includes:

1285:, is thought to be related to chronic straining during 1281:

The condition, along with complete rectal prolapse and

1165:

Rectopexy has been shown to improve anal incontinence (

654:. This proved an older theory from the 18th century by 489:

significant in predicting post-operative incontinence.

426:) which may show the associated mucosal abnormalities. 5162:

Gilrane TB, Orchard JL, Al-Assaad ZA (December 1987).

2870: 2868: 2866: 2864: 2862: 2860: 2858: 2856: 2854: 2467:

Advanced therapy in gastroenterology and liver disease

1056:, namely deficient recto-vaginal ligamentous support. 980:

during defecation, urgency, frequency or intermittent

27:

Protrusion of the walls of the rectum outside the body

5482:

European Journal of Gastroenterology & Hepatology

2852: 2850: 2848: 2846: 2844: 2842: 2840: 2838: 2836: 2834: 1622:

Stopping straining during bowel movements, by use of

544:, (50-80% of patients) which may simply present as a 5936: 5306:

Blackburn C, McDermott M, Bourke B (February 2012).

4960:

Saadah OI, Al-Hubayshi MS, Ghanem AT (August 2010).

4862:

Kang YS, Kamm MA, Engel AF, Talbot IC (April 1996).

3017:

Hampton BS (January 2009). "Pelvic organ prolapse".

1357: 1352:, caused by straining and increased pressure during 1282: 558:(a sensation of incomplete evacuation of stool) and 514:, or have a predisposing disorder (e.g., congenital 367:

Type 3: Internal-external recto-anal intussusception

7328: 7214: 7207: 7148: 7062: 7019: 6865: 6856: 6809: 6763: 6718: 6604: 6491: 6381: 6368: 6243: 6117: 6108: 6021: 5940: 5312:

Journal of Pediatric Gastroenterology and Nutrition

3250:"Rectal prolapse repair on Encyclopedia of Surgery" 2905:. Lippincott Williams & Wilkins. 2008. p. 2545:"Rectal Prolapse on Pittsburgh Colorectal Surgeons" 1652:Ulceration may persist even when symptoms resolve. 1121:to relieve constipation and straining. If there is 263:

Grade I: nonrelaxation of the sphincter mechanism (

73: 40: 35: 2900: 2400: 2398: 2396: 2394: 2392: 2390: 2388: 2386: 2384: 2382: 2380: 2378: 2376: 2374: 2372: 2370: 2368: 2366: 2364: 2362: 2360: 2358: 2356: 2354: 2352: 2350: 2348: 2346: 1995:"ASCRS core subjects: Prolapse andIntussusception" 1877:Rectal Prolapse: Diagnosis and Clinical Management 1779:section of rectal wall, which telescopes into the 1048:. One study concluded that intussusception of the 782:) or stool softener can also reduce constipation. 44:Complete rectal prolapse, external rectal prolapse 4463: 4461: 4459: 3414:"Functional disorders: rectoanal intussusception" 2344: 2342: 2340: 2338: 2336: 2334: 2332: 2330: 2328: 2326: 2018:"How stapled resection can treat rectal prolapse" 1607:as the investigation of choice to diagnose SRUS. 1184:from a similar stapling procedure for prolapsing 3143: 3141: 2292: 2290: 2288: 2286: 2284: 2282: 3189: 3187: 1460:, or non-relaxation/paradoxical contraction of 1456:More effort is required because of concomitant 184:present at rest, or occurring during straining. 99:to such a degree that they protrude out of the 61:. full thickness external rectal prolapse, and 5355:Umar SB, Efron JE, Heigh RI (September 2008). 5056:Indian Journal of Pathology & Microbiology 4054: 4052: 4050: 4048: 2407:The ASCRS textbook of colon and rectal surgery 1023:, indeed the 2 conditions can occur together. 342:Type 1: Internal recto-rectal intussusception 301:A. Normal anatomy: (r) rectum, (a) anal canal 290:second degree when it reached the dentate line 6085: 5561:Current Treatment Options in Gastroenterology 5121:Current Treatment Options in Gastroenterology 4150: 4148: 3849: 3847: 3802: 3800: 2496: 2494: 2492: 2490: 2488: 2486: 2223: 207:American Society of Colon and Rectal Surgeons 8: 6191:Esophagogastric junction outflow obstruction 5694:Vaizey CJ, Roy AJ, Kamm MA (December 1997). 3903: 3901: 2228:Tou S, Brown SR, Nelson RL (November 2015). 2221: 2219: 2217: 2215: 2213: 2211: 2209: 2207: 2205: 2203: 714:pelvic neuropathies and neurological disease 484:Anal electromyography/pudendal nerve testing 353:Type 2: Internal recto-anal intussusception 5013:International Journal of Colorectal Disease 4721: 4719: 3810:International Journal of Colorectal Disease 2797:International Journal of Colorectal Disease 2234:The Cochrane Database of Systematic Reviews 1179:Stapled trans-anal rectal resection (STARR) 1152:Laparoscopic ventral (mesh) rectopexy (LVR) 439:may demonstrate associated conditions like 293:third degree when it reached the anal verge 7211: 6862: 6378: 6230:Esophageal intramural pseudodiverticulosis 6114: 6092: 6078: 6070: 5937: 5357:"An interesting case of mistaken identity" 4966:World Journal of Gastrointestinal Oncology 1474:The site of the ulcer is typically on the 1235:(outlet obstruction). and rectal malodor. 1231:Rectal mucosal prolapse can be a cause of 49: 32: 5863: 5833: 5831: 5760: 5719: 5670: 5429: 5380: 5323: 5279: 5269: 5228: 5179: 5079: 5077: 4987: 4977: 4936: 4887: 4838: 4789: 4699: 4650: 4594: 4592: 4493: 4310: 4084: 4019:Gastroenterology Clinics of North America 3881: 3871: 3478: 3437: 3296: 3219: 2957: 2947: 2744: 2734: 2684: 2662: 2660: 2658: 2638: 2253: 1851: 5887: 5885: 5883: 5301: 5299: 4624: 4622: 3985: 3983: 3676:The American Journal of Gastroenterology 3555:Scandinavian Journal of Gastroenterology 3407: 3405: 3403: 2930:Saleem MM, Al-Momani H (December 2006). 886:This procedure can be carried out under 134: 4813:Madigan MR, Morson BC (November 1969). 4468:Pescatori M, Gagliardi G (March 2008). 2712: 2710: 2708: 2706: 2704: 2146:"Prolapse, Intussusception, & SRUS" 1836:"Rectal prolapse: a 10-year experience" 1826: 1630:intake (possibly included bulk forming 554:(20-50% of patients) also described as 4759: 4757: 4728:AJR. American Journal of Roentgenology 3101: 3091: 217:layers separating from the underlying 6458:Small intestinal bacterial overgrowth 1052:rectal wall shares the same cause as 1040:. They reported abnormalities of the 882:Anal encirclement (Thirsch procedure) 406:Proctoscopy/sigmoidoscopy/colonoscopy 146:. External (complete) rectal prolapse 7: 5915:"Procidentia on the Free Dictionary" 3124:The Lecturio Medical Concept Library 1413:Sensation of incomplete evacuation ( 5844:Clinics in Colon and Rectal Surgery 3418:Clinics in Colon and Rectal Surgery 2547:. West Penn Allegheny Health System 2409:. New York: Springer. p. 674. 1038:stapled trans-anal rectal resection 803:and gaining surgical access to the 645:, In 1968 Broden and Snellman used 322:Recto-rectal (high) intussusception 273:Grade III: moderate intussusception 189:External (complete) rectal prolapse 142:. Internal rectal intussusception. 3720:Neurogastroenterology and Motility 3412:Weiss EG, McLemore EC (May 2008). 2983:New York State Journal of Medicine 2770:The Netherlands Journal of Surgery 1344:(SRUS, SRU), is a disorder of the 1228:, although they may look similar. 25: 7343:Spontaneous bacterial peritonitis 7190:Exocrine pancreatic insufficiency 5258:Saudi Journal of Gastroenterology 3518:(11): 1026–8, discussion 1028–9. 3019:Medicine and Health, Rhode Island 1251:causing staining of undergarments 7088:Secondary sclerosing cholangitis 5806:10.1046/j.1365-2168.1998.00935.x 5762:10.1046/j.1365-2168.1998.00854.x 5410:The British Journal of Radiology 5361:Case Reports in Gastroenterology 5215:(6): 895–903, discussion 903–5. 5209:Diseases of the Colon and Rectum 4555:Diseases of the Colon and Rectum 4303:10.1111/j.1463-1318.2008.01714.x 4256:10.1111/j.1463-1318.2009.01934.x 4169:10.1111/j.1463-1318.2009.01859.x 4111:Diseases of the Colon and Rectum 3732:10.1111/j.1365-2982.2011.01850.x 3688:10.1111/j.1572-0241.2005.41114.x 3633:Diseases of the Colon and Rectum 3590:Diseases of the Colon and Rectum 3512:Diseases of the Colon and Rectum 3366:Diseases of the Colon and Rectum 3335:10.1111/j.1463-1318.2010.02327.x 3150:Diseases of the Colon and Rectum 2902:"Professional Guide to Diseases" 2686:10.2169/internalmedicine.50.5924 1875:Altomare DF, Pucciani F (2007). 1743:- "action of undertaking", from 929:Internal intussusception may be 593:(swelling) and facilitate this. 410:These may reveal congestion and 332:Recto-anal (low) intussusception 303:B. Recto-rectal intussusception 276:Grade IV: severe intussusception 6329:Gastric antral vascular ectasia 6324:Portal hypertensive gastropathy 6201:Gastroesophageal reflux disease 5604:Digestive Diseases and Sciences 5518:Digestive Diseases and Sciences 3922:10.1148/radiology.174.1.2294538 2503:Scandinavian Journal of Surgery 1660:A group of conditions known as 1358:internal rectal intussusception 1283:internal rectal intussusception 1060:Comorbidities and complications 933:, but common symptoms include: 899:Internal rectal intussusception 894:Internal rectal intussusception 696:a patulous, weak anal sphincter 641:Shortly after the invention of 195:Internal rectal intussusception 7083:Primary sclerosing cholangitis 6933:Hepatic veno-occlusive disease 6755:Solitary rectal ulcer syndrome 5794:The British Journal of Surgery 5749:The British Journal of Surgery 4815:"Solitary ulcer of the rectum" 3992:"Prolapse and intussusception" 3467:The British Journal of Surgery 2305:. New York: Springer. p. 2276:Altomare, Pucciani (2007) p.14 2246:10.1002/14651858.CD001758.pub3 1755:Merriam-Webster.com Dictionary 1731:Intussusception is defined as 1705:Merriam-Webster.com Dictionary 1342:Solitary rectal ulcer syndrome 1337:Solitary rectal ulcer syndrome 1074:Solitary rectal ulcer syndrome 1028:solitary rectal ulcer syndrome 1001:solitary rectal ulcer syndrome 270:Grade II: mild intussusception 242:Solitary rectal ulcer syndrome 111:(mucus coming from the anus), 1: 7140:Sphincter of Oddi dysfunction 5181:10.1016/s0016-5107(87)71703-9 4917:Journal of Clinical Pathology 2020:. Contemporary surgery online 1775:Intussusceptum refers to the 1384:(rectal outlet obstruction). 537:history of a protruding mass. 305:C. Recto-anal intussusception 201:) wall that can occur during 7049:Postcholecystectomy syndrome 6568:Intestinal pseudoobstruction 6176:Esophageal motility disorder 5494:10.1097/MEG.0b013e32834b0dee 5325:10.1097/MPG.0b013e31823014c0 5098:10.1016/0016-5085(87)90868-7 4519:Techniques in Coloproctology 4474:Techniques in Coloproctology 4422:Techniques in Coloproctology 4379:Techniques in Coloproctology 4336:Techniques in Coloproctology 4123:10.1097/DCR.0b013e3182a85aa6 2877:Textbook of gastroenterology 2568:Techniques in Coloproctology 2465:Bayless TM, Diehl A (2005). 1534:Diagnosis and investigations 1380:, incomplete evacuation and 851:, thus avoid the risks of a 533:Signs and symptoms include: 480:further improve continence. 443:, vaginal vault prolapse or 5838:Cannon JA (February 2017). 4601:Clinics in Gastroenterology 3854:Hasan HM, Hasan HM (2012). 2297:Zbar AP, Wexner SD (2010). 909:wall that can occur during 859:Perineal rectosigmoidectomy 666:and protruding externally. 7401: 7034:Gallstone / Cholelithiasis 6558:Functional colonic disease 6354:Zollinger–Ellison syndrome 5455:The Ceylon Medical Journal 5252:Yagnik VD (Jul–Aug 2011). 5168:Gastrointestinal Endoscopy 3078:10.1164/rccm.201204-0596PP 2515:10.1177/145749690609500307 1514:Electromyography may show 1334: 1155: 1087:digital rectal examination 708:) (have never given birth) 674:) and anatomical factors: 565:a feeling of bearing down. 6235:Acute esophageal necrosis 5573:10.1007/s11938-002-0043-9 5221:10.1007/s10350-004-0531-1 5133:10.1007/s11938-002-0045-7 4740:10.2214/ajr.164.1.7998576 4567:10.1007/s10350-008-9378-1 4531:10.1007/s10151-008-0412-z 4486:10.1007/s10151-008-0391-0 4434:10.1007/s10151-008-0389-z 4391:10.1007/s10151-006-0310-1 4348:10.1007/s10151-003-0026-4 4077:10.1007/s00464-010-1501-4 4031:10.1016/j.gtc.2008.06.001 3822:10.1007/s00384-008-0522-0 3775:10.1007/s00192-007-0513-7 3645:10.1007/s10350-004-0834-2 3567:10.3109/00365529509093309 3252:. Encyclopedia of Surgery 3064:"Definition and Overview" 2580:10.1007/s10151-005-0219-0 2469:. PMPH-USA. p. 521. 1662:Mucosal prolapse syndrome 1656:Mucosal prolapse syndrome 1638:), stool softeners (e.g. 747:The assumed mechanism of 576:and erratic bowel habits. 253:Mucosal prolapse syndrome 236:Internal mucosal prolapse 91:occurs when walls of the 57: 48: 6334:Gastric dumping syndrome 6209:Laryngopharyngeal reflux 6196:Diffuse esophageal spasm 1879:. Springer. p. 12. 1494:colitis cystica profunda 966:intussusceptions may be 493:Complete rectal prolapse 458:may be used to rule out 279:Grade V: rectal prolapse 6950:Alcoholic liver disease 6483:Bile acid malabsorption 6427:Peptic (duodenal) ulcer 5663:10.1136/gut.2003.025643 5271:10.4103/1319-3767.82592 4929:10.1136/jcp.2009.067801 3994:. ASCRS. Archived from 3289:10.1093/bjsopen/zrac018 2736:10.1186/1471-230X-12-72 2631:10.2310/6620.2011.11017 2148:. ASCRS. Archived from 2144:Madhulika G, Varma MD. 1208:Rectal mucosal prolapse 827:Laparoscopic procedures 456:Colonic transit studies 451:Colonic transit studies 6960:Hepatic encephalopathy 6344:Buried bumper syndrome 6275:Peptic (gastric) ulcer 6159:Mallory–Weiss syndrome 6102:human digestive system 5892:Lhooq M (2014-06-17). 5856:10.1055/s-0036-1593431 4979:10.4251/wjgo.v2.i8.332 4782:10.1136/gut.34.10.1422 4692:10.1136/gut.28.10.1228 4643:10.1542/peds.110.6.e79 3430:10.1055/s-2008-1075861 3212:10.1136/gut.30.12.1737 3051:. Parasites In Humans. 2949:10.1186/1471-2482-6-19 1042:enteric nervous system 717:high gastrointestinal 620: 502: 359:Type 2N Narrowed lumen 348:Type 1N Narrowed lumen 306: 147: 7185:Pancreatic pseudocyst 7054:Porcelain gallbladder 6166:Zenker's diverticulum 4831:10.1136/gut.10.11.871 3045:"Trichuris Trichiura" 2809:10.1007/s003840050218 1806:Obstructed defecation 1720:- "to fall forward". 1382:obstructed defecation 1233:obstructed defecation 1091:defecating proctogram 1033:obstructed defecation 944:obstructed defecation 687:long rectal mesentery 672:obstructed defecation 604: 560:obstructed defecation 512:obstructed defecation 500: 300: 138: 121:obstructed defecation 6989:Hepatorenal syndrome 6928:Budd–Chiari syndrome 6885:Autoimmune hepatitis 6710:Intestinal adhesions 6468:Short bowel syndrome 6297:Functional dyspepsia 6215:Esophageal stricture 6181:Nutcracker esophagus 5712:10.1136/gut.41.6.817 5422:10.1259/bjr/24752209 4880:10.1136/gut.38.4.587 3808:prospective study". 2723:BMC Gastroenterology 1564:infectious disorders 849:intravenous sedation 815:Abdominal procedures 386:Physical examination 161:layer only (partial) 7128:Choledocholithiasis 6999:Metabolic disorders 6965:Acute liver failure 6938:Portal hypertension 6890:Alcoholic hepatitis 6733:Radiation proctitis 6652:Mesenteric ischemia 6624:Gastroenterocolitis 6453:Blind loop syndrome 6263:Ménétrier's disease 6171:Barrett's esophagus 3873:10.5402/2012/652345 2152:on 14 December 2013 1840:The Ochsner Journal 1640:polyethylene glycol 1368:, but it can cause 1095:anorectal manometry 841:regional anesthetic 834:Perineal procedures 823:(keyhole surgery). 660:Albrecht von Haller 466:Anorectal manometry 18:Rosebud pornography 7380:Colorectal surgery 7303:Undefined location 7294:Grynfeltt–Lesshaft 7195:Pancreatic fistula 7178:Pancreatic abscess 7133:Biliary dyskinesia 7104:Mirizzi's syndrome 6605:Large and/or small 6285:Dieulafoy's lesion 6154:Boerhaave syndrome 6022:External resources 5616:10.1007/bf01311251 5530:10.1007/bf01536986 5416:(995): e221–e224. 5025:10.1007/bf00341203 4291:Colorectal Disease 4244:Colorectal Disease 4213:10.1111/codi.12443 4201:Colorectal Disease 4157:Colorectal Disease 4065:Surgical Endoscopy 3998:on 24 January 2013 3958:10.1111/codi.12367 3946:Colorectal Disease 3602:10.1007/bf02587429 3524:10.1007/bf02252991 3378:10.1007/bf02554307 3323:Colorectal Disease 3162:10.1007/bf02055439 2186:10.1111/codi.12751 1801:Fecal incontinence 1758:. Merriam-Webster. 1724:usually refers to 1708:. Merriam-Webster. 1430:fecal incontinence 1392:Symptoms include: 1298:muscularis propria 1046:estrogen receptors 1009:outlet obstruction 982:fecal incontinence 853:general anesthetic 749:fecal incontinence 621: 542:fecal incontinence 529:Signs and symptoms 506:life-threatening. 503: 356:Type 2W Wide Lumen 345:Type 1W Wide lumen 307: 148: 117:fecal incontinence 7367: 7366: 7363: 7362: 7203: 7202: 6805: 6804: 6662:Bowel obstruction 6364: 6363: 6067: 6066: 5800:(12): 1617–1623. 5610:(11): 1005–1008. 5524:(11): 1345–1352. 5488:(12): 1262–1266. 5373:10.1159/000154816 4923:(11): 1034–1036. 4776:(10): 1422–1426. 4686:(10): 1228–1233. 4561:(11): 1611–1618. 4207:(12): e749–e756. 4117:(12): 1409–1414. 4025:(3): 645–68, ix. 3952:(11): e680–e685. 3206:(12): 1737–1749. 3120:"Cystic Fibrosis" 3062:Vestbo J (2013). 2916:978-0-7817-7899-2 2886:978-1-4051-6911-0 2679:(21): 2569–2573. 2673:Internal Medicine 2476:978-1-55009-248-6 2416:978-0-387-24846-2 2316:978-1-84882-755-4 1886:978-88-470-0683-6 1750:"Intussusception" 1423:, or more rarely 1396:Straining during 1158:Ventral rectopexy 888:local anaesthetic 868:Delorme Procedure 693:levator diastasis 690:a deep cul-de-sac 430:Videodefecography 420:colorectal cancer 219:muscularis mucosa 85: 84: 30:Medical condition 16:(Redirected from 7392: 7355:Pneumoperitoneum 7212: 7122:Common bile duct 7004:Wilson's disease 6994:Peliosis hepatis 6863: 6740:Proctalgia fugax 6647:Abdominal angina 6572:Ogilvie syndrome 6521:Pseudomembranous 6379: 6339:Gastric volvulus 6304:Pyloric stenosis 6115: 6100:Diseases of the 6094: 6087: 6080: 6071: 5938: 5927: 5926: 5924: 5922: 5911: 5905: 5904: 5902: 5901: 5889: 5878: 5877: 5867: 5835: 5826: 5825: 5789: 5783: 5782: 5764: 5755:(9): 1246–1250. 5740: 5734: 5733: 5723: 5691: 5685: 5684: 5674: 5642: 5636: 5635: 5599: 5593: 5592: 5556: 5550: 5549: 5512: 5506: 5505: 5477: 5471: 5470: 5450: 5444: 5443: 5433: 5401: 5395: 5394: 5384: 5352: 5346: 5345: 5327: 5303: 5294: 5293: 5283: 5273: 5249: 5243: 5242: 5232: 5200: 5194: 5193: 5183: 5159: 5153: 5152: 5116: 5110: 5109: 5086:Gastroenterology 5081: 5072: 5071: 5051: 5045: 5044: 5008: 5002: 5001: 4991: 4981: 4957: 4951: 4950: 4940: 4908: 4902: 4901: 4891: 4859: 4853: 4852: 4842: 4810: 4804: 4803: 4793: 4761: 4752: 4751: 4723: 4714: 4713: 4703: 4671: 4665: 4664: 4654: 4626: 4617: 4616: 4596: 4587: 4586: 4549: 4543: 4542: 4514: 4508: 4507: 4497: 4465: 4454: 4453: 4417: 4411: 4410: 4374: 4368: 4367: 4331: 4325: 4324: 4314: 4282: 4276: 4275: 4239: 4233: 4232: 4195: 4189: 4188: 4152: 4143: 4142: 4105: 4099: 4098: 4088: 4071:(6): 2000–2003. 4056: 4043: 4042: 4014: 4008: 4007: 4005: 4003: 3987: 3978: 3977: 3940: 3934: 3933: 3905: 3896: 3895: 3885: 3875: 3851: 3842: 3841: 3816:(10): 999–1005. 3804: 3795: 3794: 3758: 3752: 3751: 3726:(3): e155–e161. 3714: 3708: 3707: 3682:(7): 1578–1585. 3671: 3665: 3664: 3628: 3622: 3621: 3585: 3579: 3578: 3550: 3544: 3543: 3507: 3501: 3500: 3482: 3480:10.1002/bjs.4912 3458: 3452: 3451: 3441: 3409: 3398: 3397: 3361: 3355: 3354: 3317: 3311: 3310: 3300: 3268: 3262: 3261: 3259: 3257: 3245: 3234: 3233: 3223: 3191: 3182: 3181: 3145: 3136: 3135: 3133: 3131: 3116: 3110: 3109: 3103: 3099: 3097: 3089: 3059: 3053: 3052: 3041: 3035: 3034: 3014: 3008: 3005: 2999: 2998: 2978: 2972: 2971: 2961: 2951: 2927: 2921: 2920: 2904: 2897: 2891: 2890: 2872: 2829: 2828: 2803:(4–5): 245–249. 2792: 2786: 2785: 2765: 2759: 2758: 2748: 2738: 2714: 2699: 2698: 2688: 2664: 2653: 2652: 2642: 2614: 2608: 2607: 2563: 2557: 2556: 2554: 2552: 2541: 2535: 2534: 2498: 2481: 2480: 2462: 2456: 2455: 2453: 2451: 2440: 2421: 2420: 2402: 2321: 2320: 2304: 2294: 2277: 2274: 2268: 2267: 2257: 2240:(11): CD001758. 2225: 2198: 2197: 2168: 2162: 2161: 2159: 2157: 2141: 2030: 2029: 2027: 2025: 2013: 2007: 2006: 2004: 2002: 1990: 1891: 1890: 1872: 1866: 1865: 1855: 1831: 1811:Rectal discharge 1762:intussusceptions 1759: 1747:- "to take up". 1726:uterine prolapse 1709: 1601:electromyography 1573:mucus-producing 1498:cystica profunda 1404:rectal discharge 1261:rectal discharge 1203:Mucosal prolapse 1142:sacral vertebrae 845:local anesthetic 731:cystic fibrosis 647:cinedefecography 633:pouch of Douglas 546:mucous discharge 226:Mucosal prolapse 109:mucous discharge 67:mucosal prolapse 53: 33: 21: 7400: 7399: 7395: 7394: 7393: 7391: 7390: 7389: 7385:Rectal diseases 7370: 7369: 7368: 7359: 7324: 7313:Internal hernia 7199: 7144: 7109:Biliary fistula 7067: 7058: 7044:Adenomyomatosis 7039:Cholesterolosis 7015: 7009:Hemochromatosis 6880:Viral hepatitis 6852: 6801: 6759: 6745:Rectal prolapse 6714: 6681:Fecal impaction 6671:Intussusception 6634:Crohn's disease 6600: 6583:Toxic megacolon 6495: 6493:Large intestine 6487: 6432:Curling's ulcer 6385: 6383:Small intestine 6372: 6360: 6268:Gastroenteritis 6239: 6104: 6098: 6068: 6063: 6062: 6058:Rectal prolapse 6017: 6016: 5949: 5935: 5930: 5920: 5918: 5913: 5912: 5908: 5899: 5897: 5891: 5890: 5881: 5837: 5836: 5829: 5791: 5790: 5786: 5742: 5741: 5737: 5693: 5692: 5688: 5644: 5643: 5639: 5601: 5600: 5596: 5558: 5557: 5553: 5514: 5513: 5509: 5479: 5478: 5474: 5452: 5451: 5447: 5403: 5402: 5398: 5354: 5353: 5349: 5305: 5304: 5297: 5251: 5250: 5246: 5202: 5201: 5197: 5161: 5160: 5156: 5118: 5117: 5113: 5083: 5082: 5075: 5053: 5052: 5048: 5010: 5009: 5005: 4959: 4958: 4954: 4910: 4909: 4905: 4861: 4860: 4856: 4825:(11): 871–881. 4812: 4811: 4807: 4763: 4762: 4755: 4725: 4724: 4717: 4673: 4672: 4668: 4628: 4627: 4620: 4607:(4): 985–1002. 4598: 4597: 4590: 4551: 4550: 4546: 4516: 4515: 4511: 4467: 4466: 4457: 4419: 4418: 4414: 4376: 4375: 4371: 4333: 4332: 4328: 4284: 4283: 4279: 4241: 4240: 4236: 4197: 4196: 4192: 4154: 4153: 4146: 4107: 4106: 4102: 4058: 4057: 4046: 4016: 4015: 4011: 4001: 3999: 3989: 3988: 3981: 3942: 3941: 3937: 3907: 3906: 3899: 3853: 3852: 3845: 3806: 3805: 3798: 3760: 3759: 3755: 3716: 3715: 3711: 3673: 3672: 3668: 3630: 3629: 3625: 3587: 3586: 3582: 3552: 3551: 3547: 3509: 3508: 3504: 3460: 3459: 3455: 3411: 3410: 3401: 3372:(12): 920–924. 3363: 3362: 3358: 3319: 3318: 3314: 3270: 3269: 3265: 3255: 3253: 3247: 3246: 3237: 3193: 3192: 3185: 3147: 3146: 3139: 3129: 3127: 3126:. 7 August 2020 3118: 3117: 3113: 3100: 3090: 3061: 3060: 3056: 3043: 3042: 3038: 3016: 3015: 3011: 3006: 3002: 2980: 2979: 2975: 2929: 2928: 2924: 2917: 2899: 2898: 2894: 2887: 2874: 2873: 2832: 2794: 2793: 2789: 2767: 2766: 2762: 2716: 2715: 2702: 2666: 2665: 2656: 2616: 2615: 2611: 2565: 2564: 2560: 2550: 2548: 2543: 2542: 2538: 2500: 2499: 2484: 2477: 2464: 2463: 2459: 2449: 2447: 2442: 2441: 2424: 2417: 2404: 2403: 2324: 2317: 2296: 2295: 2280: 2275: 2271: 2227: 2226: 2201: 2170: 2169: 2165: 2155: 2153: 2143: 2142: 2033: 2023: 2021: 2015: 2014: 2010: 2000: 1998: 1992: 1991: 1894: 1887: 1874: 1873: 1869: 1833: 1832: 1828: 1824: 1797: 1770:small intestine 1748: 1739:- "within" and 1698: 1687: 1678: 1670: 1658: 1624:correct posture 1617:quality of life 1613: 1587:, transrectal 1536: 1524: 1518:motor latency. 1447: 1439: 1409:Rectal bleeding 1390: 1374:rectal bleeding 1339: 1333: 1322: 1313: 1279: 1255:Rectal bleeding 1241: 1205: 1193:contraindicated 1181: 1160: 1154: 1103: 1083: 1062: 993: 957:Rectal bleeding 927: 896: 836: 817: 788: 775: 770: 599: 569:rectal bleeding 531: 495: 486: 468: 460:colonic inertia 453: 432: 408: 388: 379: 374: 304: 302: 175:circumferential 133: 113:rectal bleeding 89:rectal prolapse 80:General surgery 36:Rectal prolapse 31: 28: 23: 22: 15: 12: 11: 5: 7398: 7396: 7388: 7387: 7382: 7372: 7371: 7365: 7364: 7361: 7360: 7358: 7357: 7352: 7350:Hemoperitoneum 7347: 7346: 7345: 7334: 7332: 7326: 7325: 7323: 7322: 7321: 7320: 7315: 7310: 7299: 7298: 7297: 7296: 7291: 7278: 7277: 7272: 7267: 7262: 7257: 7256: 7255: 7250: 7239: 7238: 7233: 7232: 7231: 7220: 7218: 7209: 7205: 7204: 7201: 7200: 7198: 7197: 7192: 7187: 7182: 7181: 7180: 7175: 7170: 7165: 7154: 7152: 7146: 7145: 7143: 7142: 7137: 7136: 7135: 7130: 7117: 7116: 7111: 7106: 7097: 7096: 7095: 7090: 7085: 7074: 7072: 7060: 7059: 7057: 7056: 7051: 7046: 7041: 7036: 7031: 7025: 7023: 7017: 7016: 7014: 7013: 7012: 7011: 7006: 6996: 6991: 6986: 6985: 6984: 6979: 6969: 6968: 6967: 6962: 6952: 6947: 6946: 6945: 6940: 6935: 6930: 6918: 6917: 6916: 6906: 6905: 6904: 6894: 6893: 6892: 6887: 6882: 6871: 6869: 6860: 6854: 6853: 6851: 6850: 6849: 6848: 6838: 6837: 6836: 6831: 6821: 6819:Blood in stool 6815: 6813: 6807: 6806: 6803: 6802: 6800: 6799: 6794: 6792:Anal dysplasia 6789: 6784: 6779: 6769: 6767: 6761: 6760: 6758: 6757: 6752: 6747: 6742: 6737: 6736: 6735: 6724: 6722: 6716: 6715: 6713: 6712: 6707: 6706: 6705: 6695: 6694: 6693: 6683: 6678: 6673: 6668: 6659: 6657:Angiodysplasia 6654: 6649: 6638: 6637: 6636: 6626: 6621: 6620: 6619: 6608: 6606: 6602: 6601: 6599: 6598: 6592:Diverticulosis 6588:Diverticulitis 6585: 6576: 6575: 6574: 6565: 6555: 6550: 6549: 6548: 6543: 6538: 6533: 6528: 6523: 6513: 6507: 6505: 6489: 6488: 6486: 6485: 6480: 6478:Milroy disease 6475: 6470: 6465: 6460: 6455: 6450: 6448:Tropical sprue 6445: 6436: 6435: 6434: 6424: 6423: 6422: 6417: 6412: 6401: 6399: 6376: 6370:Lower GI tract 6366: 6365: 6362: 6361: 6359: 6358: 6357: 6356: 6346: 6341: 6336: 6331: 6326: 6321: 6316: 6311: 6306: 6301: 6300: 6299: 6289: 6288: 6287: 6282: 6272: 6271: 6270: 6265: 6260: 6249: 6247: 6241: 6240: 6238: 6237: 6232: 6227: 6222: 6217: 6212: 6206: 6205: 6204: 6198: 6193: 6188: 6183: 6173: 6168: 6163: 6162: 6161: 6156: 6146: 6145: 6144: 6139: 6134: 6123: 6121: 6112: 6110:Upper GI tract 6106: 6105: 6099: 6097: 6096: 6089: 6082: 6074: 6065: 6064: 6061: 6060: 6049: 6038: 6026: 6025: 6023: 6019: 6018: 6015: 6014: 6003: 5992: 5981: 5966: 5950: 5945: 5944: 5942: 5941:Classification 5934: 5933:External links 5931: 5929: 5928: 5906: 5879: 5827: 5784: 5735: 5706:(6): 817–820. 5686: 5657:(3): 368–370. 5637: 5594: 5567:(3): 215–223. 5551: 5507: 5472: 5461:(4): 241–242. 5445: 5396: 5367:(3): 308–313. 5347: 5318:(2): 263–265. 5295: 5244: 5195: 5174:(6): 467–468. 5154: 5127:(3): 231–237. 5111: 5092:(1): 243–253. 5073: 5046: 5003: 4972:(8): 332–334. 4952: 4903: 4874:(4): 587–590. 4854: 4805: 4753: 4715: 4666: 4618: 4588: 4544: 4525:(2): 135–136. 4509: 4455: 4412: 4385:(4): 361–363. 4369: 4342:(3): 148–153. 4326: 4297:(8): 821–827. 4277: 4250:(6): 504–512. 4234: 4190: 4163:(6): 526–532. 4144: 4100: 4044: 4009: 3979: 3935: 3916:(1): 124–126. 3897: 3843: 3796: 3769:(5): 705–710. 3753: 3709: 3666: 3639:(4): 824–831. 3623: 3596:(5): 391–396. 3580: 3561:(5): 470–472. 3545: 3502: 3473:(7): 866–872. 3453: 3424:(2): 122–128. 3399: 3356: 3329:(8): 914–917. 3312: 3283:(2): zrac018. 3263: 3235: 3183: 3156:(7): 817–820. 3137: 3111: 3102:|journal= 3054: 3036: 3009: 3000: 2989:(4): 697–698. 2973: 2922: 2915: 2892: 2885: 2830: 2787: 2776:(6): 145–148. 2760: 2700: 2654: 2625:(4): 227–229. 2609: 2574:(2): 163–165. 2558: 2536: 2509:(3): 166–171. 2482: 2475: 2457: 2422: 2415: 2322: 2315: 2301:Coloproctology 2278: 2269: 2199: 2163: 2031: 2008: 1892: 1885: 1867: 1825: 1823: 1820: 1819: 1818: 1813: 1808: 1803: 1796: 1793: 1697:- "to slide". 1693:- "forward" + 1686: 1683: 1677: 1674: 1669: 1666: 1657: 1654: 1612: 1609: 1578: 1577: 1575:adenocarcinoma 1571: 1565: 1562: 1556: 1551: 1535: 1532: 1523: 1520: 1516:pudendal nerve 1480:rectal ampulla 1446: 1443: 1438: 1435: 1434: 1433: 1427: 1418: 1411: 1406: 1400: 1389: 1386: 1378:rectal malodor 1335:Main article: 1332: 1329: 1321: 1318: 1312: 1309: 1278: 1275: 1274: 1273: 1268: 1263: 1257: 1252: 1240: 1237: 1204: 1201: 1180: 1177: 1156:Main article: 1153: 1150: 1102: 1099: 1082: 1079: 1078: 1077: 1071: 1061: 1058: 1026:Patients with 992: 989: 961: 960: 954: 951: 940: 926: 923: 895: 892: 835: 832: 816: 813: 787: 784: 774: 771: 769: 766: 738:pudendal nerve 733: 732: 729: 726: 715: 712: 709: 698: 697: 694: 691: 688: 685: 682: 679: 614:lamina propria 598: 595: 578: 577: 571: 566: 563: 549: 538: 530: 527: 494: 491: 485: 482: 467: 464: 452: 449: 431: 428: 407: 404: 387: 384: 378: 375: 373: 370: 369: 368: 365: 364: 363: 360: 357: 351: 350: 349: 346: 295: 294: 291: 288: 281: 280: 277: 274: 271: 268: 186: 185: 182: 172: 171:if they do not 162: 155:full thickness 132: 131:Classification 129: 83: 82: 77: 71: 70: 55: 54: 46: 45: 42: 38: 37: 29: 26: 24: 14: 13: 10: 9: 6: 4: 3: 2: 7397: 7386: 7383: 7381: 7378: 7377: 7375: 7356: 7353: 7351: 7348: 7344: 7341: 7340: 7339: 7336: 7335: 7333: 7331: 7327: 7319: 7316: 7314: 7311: 7309: 7306: 7305: 7304: 7301: 7300: 7295: 7292: 7290: 7287: 7286: 7285: 7284: 7280: 7279: 7276: 7273: 7271: 7268: 7266: 7263: 7261: 7258: 7254: 7251: 7249: 7246: 7245: 7244: 7241: 7240: 7237: 7234: 7230: 7227: 7226: 7225: 7224:Diaphragmatic 7222: 7221: 7219: 7217: 7213: 7210: 7206: 7196: 7193: 7191: 7188: 7186: 7183: 7179: 7176: 7174: 7171: 7169: 7166: 7164: 7161: 7160: 7159: 7156: 7155: 7153: 7151: 7147: 7141: 7138: 7134: 7131: 7129: 7126: 7125: 7124: 7123: 7119: 7118: 7115: 7112: 7110: 7107: 7105: 7101: 7098: 7094: 7091: 7089: 7086: 7084: 7081: 7080: 7079: 7076: 7075: 7073: 7071: 7065: 7061: 7055: 7052: 7050: 7047: 7045: 7042: 7040: 7037: 7035: 7032: 7030: 7029:Cholecystitis 7027: 7026: 7024: 7022: 7018: 7010: 7007: 7005: 7002: 7001: 7000: 6997: 6995: 6992: 6990: 6987: 6983: 6980: 6978: 6975: 6974: 6973: 6972:Liver abscess 6970: 6966: 6963: 6961: 6958: 6957: 6956: 6955:Liver failure 6953: 6951: 6948: 6944: 6941: 6939: 6936: 6934: 6931: 6929: 6926: 6925: 6924: 6923: 6919: 6915: 6912: 6911: 6910: 6907: 6903: 6900: 6899: 6898: 6895: 6891: 6888: 6886: 6883: 6881: 6878: 6877: 6876: 6873: 6872: 6870: 6868: 6864: 6861: 6859: 6855: 6847: 6844: 6843: 6842: 6839: 6835: 6832: 6830: 6827: 6826: 6825: 6822: 6820: 6817: 6816: 6814: 6812: 6808: 6798: 6795: 6793: 6790: 6788: 6785: 6783: 6780: 6778: 6774: 6771: 6770: 6768: 6766: 6762: 6756: 6753: 6751: 6748: 6746: 6743: 6741: 6738: 6734: 6731: 6730: 6729: 6726: 6725: 6723: 6721: 6717: 6711: 6708: 6704: 6701: 6700: 6699: 6696: 6692: 6689: 6688: 6687: 6684: 6682: 6679: 6677: 6674: 6672: 6669: 6667: 6663: 6660: 6658: 6655: 6653: 6650: 6648: 6644: 6643: 6639: 6635: 6632: 6631: 6630: 6627: 6625: 6622: 6618: 6615: 6614: 6613: 6612:Enterocolitis 6610: 6609: 6607: 6603: 6597: 6593: 6589: 6586: 6584: 6580: 6577: 6573: 6569: 6566: 6564: 6561: 6560: 6559: 6556: 6554: 6551: 6547: 6544: 6542: 6539: 6537: 6534: 6532: 6529: 6527: 6524: 6522: 6519: 6518: 6517: 6514: 6512: 6509: 6508: 6506: 6503: 6499: 6494: 6490: 6484: 6481: 6479: 6476: 6474: 6471: 6469: 6466: 6464: 6461: 6459: 6456: 6454: 6451: 6449: 6446: 6444: 6440: 6439:Malabsorption 6437: 6433: 6430: 6429: 6428: 6425: 6421: 6418: 6416: 6413: 6411: 6408: 6407: 6406: 6403: 6402: 6400: 6397: 6393: 6389: 6384: 6380: 6377: 6375: 6371: 6367: 6355: 6352: 6351: 6350: 6347: 6345: 6342: 6340: 6337: 6335: 6332: 6330: 6327: 6325: 6322: 6320: 6317: 6315: 6314:Gastroparesis 6312: 6310: 6307: 6305: 6302: 6298: 6295: 6294: 6293: 6290: 6286: 6283: 6281: 6280:Cushing ulcer 6278: 6277: 6276: 6273: 6269: 6266: 6264: 6261: 6259: 6256: 6255: 6254: 6251: 6250: 6248: 6246: 6242: 6236: 6233: 6231: 6228: 6226: 6225:Megaesophagus 6223: 6221: 6218: 6216: 6213: 6210: 6207: 6202: 6199: 6197: 6194: 6192: 6189: 6187: 6184: 6182: 6179: 6178: 6177: 6174: 6172: 6169: 6167: 6164: 6160: 6157: 6155: 6152: 6151: 6150: 6147: 6143: 6140: 6138: 6135: 6133: 6130: 6129: 6128: 6125: 6124: 6122: 6120: 6116: 6113: 6111: 6107: 6103: 6095: 6090: 6088: 6083: 6081: 6076: 6075: 6072: 6059: 6055: 6054: 6050: 6048: 6044: 6043: 6039: 6037: 6033: 6032: 6028: 6027: 6024: 6020: 6013: 6009: 6008: 6004: 6002: 5998: 5997: 5993: 5991: 5987: 5986: 5982: 5980: 5976: 5975: 5971: 5967: 5965: 5961: 5960: 5956: 5952: 5951: 5948: 5943: 5939: 5932: 5916: 5910: 5907: 5895: 5888: 5886: 5884: 5880: 5875: 5871: 5866: 5861: 5857: 5853: 5849: 5845: 5841: 5834: 5832: 5828: 5823: 5819: 5815: 5811: 5807: 5803: 5799: 5795: 5788: 5785: 5780: 5776: 5772: 5768: 5763: 5758: 5754: 5750: 5746: 5739: 5736: 5731: 5727: 5722: 5717: 5713: 5709: 5705: 5701: 5697: 5690: 5687: 5682: 5678: 5673: 5668: 5664: 5660: 5656: 5652: 5648: 5641: 5638: 5633: 5629: 5625: 5621: 5617: 5613: 5609: 5605: 5598: 5595: 5590: 5586: 5582: 5578: 5574: 5570: 5566: 5562: 5555: 5552: 5547: 5543: 5539: 5535: 5531: 5527: 5523: 5519: 5511: 5508: 5503: 5499: 5495: 5491: 5487: 5483: 5476: 5473: 5468: 5464: 5460: 5456: 5449: 5446: 5441: 5437: 5432: 5427: 5423: 5419: 5415: 5411: 5407: 5400: 5397: 5392: 5388: 5383: 5378: 5374: 5370: 5366: 5362: 5358: 5351: 5348: 5343: 5339: 5335: 5331: 5326: 5321: 5317: 5313: 5309: 5302: 5300: 5296: 5291: 5287: 5282: 5277: 5272: 5267: 5263: 5259: 5255: 5248: 5245: 5240: 5236: 5231: 5226: 5222: 5218: 5214: 5210: 5206: 5199: 5196: 5191: 5187: 5182: 5177: 5173: 5169: 5165: 5158: 5155: 5150: 5146: 5142: 5138: 5134: 5130: 5126: 5122: 5115: 5112: 5107: 5103: 5099: 5095: 5091: 5087: 5080: 5078: 5074: 5069: 5065: 5062:(2): 94–102. 5061: 5057: 5050: 5047: 5042: 5038: 5034: 5030: 5026: 5022: 5018: 5014: 5007: 5004: 4999: 4995: 4990: 4985: 4980: 4975: 4971: 4967: 4963: 4956: 4953: 4948: 4944: 4939: 4934: 4930: 4926: 4922: 4918: 4914: 4907: 4904: 4899: 4895: 4890: 4885: 4881: 4877: 4873: 4869: 4865: 4858: 4855: 4850: 4846: 4841: 4836: 4832: 4828: 4824: 4820: 4816: 4809: 4806: 4801: 4797: 4792: 4787: 4783: 4779: 4775: 4771: 4767: 4760: 4758: 4754: 4749: 4745: 4741: 4737: 4733: 4729: 4722: 4720: 4716: 4711: 4707: 4702: 4697: 4693: 4689: 4685: 4681: 4677: 4670: 4667: 4662: 4658: 4653: 4648: 4644: 4640: 4636: 4632: 4625: 4623: 4619: 4614: 4610: 4606: 4602: 4595: 4593: 4589: 4584: 4580: 4576: 4572: 4568: 4564: 4560: 4556: 4548: 4545: 4540: 4536: 4532: 4528: 4524: 4520: 4513: 4510: 4505: 4501: 4496: 4491: 4487: 4483: 4479: 4475: 4471: 4464: 4462: 4460: 4456: 4451: 4447: 4443: 4439: 4435: 4431: 4427: 4423: 4416: 4413: 4408: 4404: 4400: 4396: 4392: 4388: 4384: 4380: 4373: 4370: 4365: 4361: 4357: 4353: 4349: 4345: 4341: 4337: 4330: 4327: 4322: 4318: 4313: 4308: 4304: 4300: 4296: 4292: 4288: 4281: 4278: 4273: 4269: 4265: 4261: 4257: 4253: 4249: 4245: 4238: 4235: 4230: 4226: 4222: 4218: 4214: 4210: 4206: 4202: 4194: 4191: 4186: 4182: 4178: 4174: 4170: 4166: 4162: 4158: 4151: 4149: 4145: 4140: 4136: 4132: 4128: 4124: 4120: 4116: 4112: 4104: 4101: 4096: 4092: 4087: 4082: 4078: 4074: 4070: 4066: 4062: 4055: 4053: 4051: 4049: 4045: 4040: 4036: 4032: 4028: 4024: 4020: 4013: 4010: 3997: 3993: 3986: 3984: 3980: 3975: 3971: 3967: 3963: 3959: 3955: 3951: 3947: 3939: 3936: 3931: 3927: 3923: 3919: 3915: 3911: 3904: 3902: 3898: 3893: 3889: 3884: 3879: 3874: 3869: 3865: 3861: 3857: 3850: 3848: 3844: 3839: 3835: 3831: 3827: 3823: 3819: 3815: 3811: 3803: 3801: 3797: 3792: 3788: 3784: 3780: 3776: 3772: 3768: 3764: 3757: 3754: 3749: 3745: 3741: 3737: 3733: 3729: 3725: 3721: 3713: 3710: 3705: 3701: 3697: 3693: 3689: 3685: 3681: 3677: 3670: 3667: 3662: 3658: 3654: 3650: 3646: 3642: 3638: 3634: 3627: 3624: 3619: 3615: 3611: 3607: 3603: 3599: 3595: 3591: 3584: 3581: 3576: 3572: 3568: 3564: 3560: 3556: 3549: 3546: 3541: 3537: 3533: 3529: 3525: 3521: 3517: 3513: 3506: 3503: 3498: 3494: 3490: 3486: 3481: 3476: 3472: 3468: 3464: 3457: 3454: 3449: 3445: 3440: 3435: 3431: 3427: 3423: 3419: 3415: 3408: 3406: 3404: 3400: 3395: 3391: 3387: 3383: 3379: 3375: 3371: 3367: 3360: 3357: 3352: 3348: 3344: 3340: 3336: 3332: 3328: 3324: 3316: 3313: 3308: 3304: 3299: 3294: 3290: 3286: 3282: 3278: 3274: 3267: 3264: 3251: 3244: 3242: 3240: 3236: 3231: 3227: 3222: 3217: 3213: 3209: 3205: 3201: 3197: 3190: 3188: 3184: 3179: 3175: 3171: 3167: 3163: 3159: 3155: 3151: 3144: 3142: 3138: 3125: 3121: 3115: 3112: 3107: 3095: 3087: 3083: 3079: 3075: 3071: 3070: 3065: 3058: 3055: 3050: 3046: 3040: 3037: 3032: 3028: 3024: 3020: 3013: 3010: 3004: 3001: 2996: 2992: 2988: 2984: 2977: 2974: 2969: 2965: 2960: 2955: 2950: 2945: 2941: 2937: 2933: 2926: 2923: 2918: 2912: 2908: 2903: 2896: 2893: 2888: 2882: 2878: 2871: 2869: 2867: 2865: 2863: 2861: 2859: 2857: 2855: 2853: 2851: 2849: 2847: 2845: 2843: 2841: 2839: 2837: 2835: 2831: 2826: 2822: 2818: 2814: 2810: 2806: 2802: 2798: 2791: 2788: 2783: 2779: 2775: 2771: 2764: 2761: 2756: 2752: 2747: 2742: 2737: 2732: 2728: 2724: 2720: 2713: 2711: 2709: 2707: 2705: 2701: 2696: 2692: 2687: 2682: 2678: 2674: 2670: 2663: 2661: 2659: 2655: 2650: 2646: 2641: 2636: 2632: 2628: 2624: 2620: 2613: 2610: 2605: 2601: 2597: 2593: 2589: 2585: 2581: 2577: 2573: 2569: 2562: 2559: 2546: 2540: 2537: 2532: 2528: 2524: 2520: 2516: 2512: 2508: 2504: 2497: 2495: 2493: 2491: 2489: 2487: 2483: 2478: 2472: 2468: 2461: 2458: 2446: 2439: 2437: 2435: 2433: 2431: 2429: 2427: 2423: 2418: 2412: 2408: 2401: 2399: 2397: 2395: 2393: 2391: 2389: 2387: 2385: 2383: 2381: 2379: 2377: 2375: 2373: 2371: 2369: 2367: 2365: 2363: 2361: 2359: 2357: 2355: 2353: 2351: 2349: 2347: 2345: 2343: 2341: 2339: 2337: 2335: 2333: 2331: 2329: 2327: 2323: 2318: 2312: 2308: 2303: 2302: 2293: 2291: 2289: 2287: 2285: 2283: 2279: 2273: 2270: 2265: 2261: 2256: 2251: 2247: 2243: 2239: 2235: 2231: 2224: 2222: 2220: 2218: 2216: 2214: 2212: 2210: 2208: 2206: 2204: 2200: 2195: 2191: 2187: 2183: 2180:(2): O34-46. 2179: 2175: 2167: 2164: 2151: 2147: 2140: 2138: 2136: 2134: 2132: 2130: 2128: 2126: 2124: 2122: 2120: 2118: 2116: 2114: 2112: 2110: 2108: 2106: 2104: 2102: 2100: 2098: 2096: 2094: 2092: 2090: 2088: 2086: 2084: 2082: 2080: 2078: 2076: 2074: 2072: 2070: 2068: 2066: 2064: 2062: 2060: 2058: 2056: 2054: 2052: 2050: 2048: 2046: 2044: 2042: 2040: 2038: 2036: 2032: 2019: 2012: 2009: 1996: 1989: 1987: 1985: 1983: 1981: 1979: 1977: 1975: 1973: 1971: 1969: 1967: 1965: 1963: 1961: 1959: 1957: 1955: 1953: 1951: 1949: 1947: 1945: 1943: 1941: 1939: 1937: 1935: 1933: 1931: 1929: 1927: 1925: 1923: 1921: 1919: 1917: 1915: 1913: 1911: 1909: 1907: 1905: 1903: 1901: 1899: 1897: 1893: 1888: 1882: 1878: 1871: 1868: 1863: 1859: 1854: 1849: 1845: 1841: 1837: 1830: 1827: 1821: 1817: 1814: 1812: 1809: 1807: 1804: 1802: 1799: 1798: 1794: 1792: 1790: 1786: 1782: 1778: 1773: 1771: 1767: 1763: 1757: 1756: 1751: 1746: 1742: 1738: 1734: 1729: 1727: 1723: 1719: 1714: 1712: 1707: 1706: 1701: 1696: 1692: 1684: 1682: 1675: 1673: 1667: 1665: 1663: 1655: 1653: 1650: 1647: 1645: 1641: 1637: 1633: 1629: 1628:dietary fiber 1625: 1620: 1618: 1610: 1608: 1606: 1602: 1598: 1594: 1590: 1586: 1585:sigmoidoscopy 1582: 1576: 1572: 1570: 1567:drug-induced 1566: 1563: 1561: 1558:inflammatory 1557: 1555: 1554:endometriosis 1552: 1550: 1547: 1546: 1545: 1542: 1539: 1533: 1531: 1529: 1522:Complications 1521: 1519: 1517: 1512: 1510: 1506: 1503: 1499: 1495: 1490: 1487: 1483: 1481: 1477: 1472: 1470: 1465: 1463: 1459: 1454: 1450: 1444: 1442: 1436: 1431: 1428: 1426: 1422: 1419: 1416: 1412: 1410: 1407: 1405: 1401: 1399: 1395: 1394: 1393: 1387: 1385: 1383: 1379: 1375: 1371: 1367: 1363: 1359: 1355: 1351: 1347: 1343: 1338: 1330: 1328: 1326: 1319: 1317: 1310: 1308: 1306: 1303: 1299: 1294: 1292: 1288: 1284: 1276: 1272: 1269: 1267: 1264: 1262: 1258: 1256: 1253: 1250: 1249:Fecal leakage 1247: 1246: 1245: 1238: 1236: 1234: 1229: 1227: 1222: 1220: 1216: 1213: 1209: 1202: 1200: 1198: 1194: 1189: 1187: 1178: 1176: 1173: 1170: 1168: 1167:fecal leakage 1163: 1159: 1151: 1149: 1145: 1143: 1139: 1134: 1132: 1128: 1127:fecal leakage 1124: 1120: 1116: 1115:suppositories 1112: 1108: 1107:bulking agent 1100: 1098: 1096: 1092: 1088: 1080: 1075: 1072: 1070: 1067: 1066: 1065: 1059: 1057: 1055: 1051: 1047: 1043: 1039: 1034: 1029: 1024: 1022: 1018: 1014: 1010: 1004: 1002: 996: 990: 988: 985: 983: 979: 975: 971: 969: 965: 958: 955: 952: 949: 945: 942:Sensation of 941: 939: 938:Fecal leakage 936: 935: 934: 932: 924: 922: 919: 914: 912: 908: 904: 900: 893: 891: 889: 884: 883: 879: 876: 870: 869: 865: 861: 860: 856: 854: 850: 846: 842: 833: 831: 828: 824: 822: 814: 812: 808: 806: 805:pelvic cavity 802: 798: 792: 785: 783: 781: 772: 767: 765: 761: 759: 753: 750: 745: 741: 739: 730: 727: 724: 720: 716: 713: 710: 707: 703: 702: 701: 695: 692: 689: 686: 683: 680: 677: 676: 675: 673: 667: 665: 661: 657: 653: 648: 644: 639: 637: 634: 628: 626: 619: 618:H&E stain 615: 611: 607: 603: 596: 594: 592: 586: 584: 575: 572: 570: 567: 564: 561: 557: 553: 550: 547: 543: 539: 536: 535: 534: 528: 526: 523: 519: 517: 513: 507: 499: 492: 490: 483: 481: 478: 474: 465: 463: 461: 457: 450: 448: 446: 442: 438: 429: 427: 425: 421: 417: 413: 405: 403: 401: 396: 392: 385: 383: 376: 371: 366: 361: 358: 355: 354: 352: 347: 344: 343: 341: 340: 339: 335: 333: 329: 327: 323: 319: 317: 313: 299: 292: 289: 286: 285: 284: 278: 275: 272: 269: 266: 262: 261: 260: 256: 254: 250: 247: 243: 239: 237: 233: 231: 227: 223: 220: 216: 212: 208: 204: 200: 196: 192: 190: 183: 180: 176: 173: 170: 166: 163: 160: 156: 153: 152: 151: 145: 141: 137: 130: 128: 124: 122: 118: 115:, degrees of 114: 110: 105: 102: 98: 94: 90: 81: 78: 76: 72: 68: 64: 60: 56: 52: 47: 43: 39: 34: 19: 7302: 7281: 7158:Pancreatitis 7120: 7070:biliary tree 6943:Nutmeg liver 6920: 6846:Hematochezia 6797:Pruritus ani 6782:Anal abscess 6777:Anal fistula 6773:Anal fissure 6744: 6686:Constipation 6640: 6511:Appendicitis 6319:Gastroptosis 6309:Achlorhydria 6148: 6137:Eosinophilic 6051: 6040: 6029: 6005: 5994: 5983: 5968: 5953: 5919:. Retrieved 5917:. Farlex Inc 5909: 5898:. Retrieved 5850:(1): 16–21. 5847: 5843: 5797: 5793: 5787: 5752: 5748: 5738: 5703: 5699: 5689: 5654: 5650: 5640: 5607: 5603: 5597: 5564: 5560: 5554: 5521: 5517: 5510: 5485: 5481: 5475: 5458: 5454: 5448: 5413: 5409: 5399: 5364: 5360: 5350: 5315: 5311: 5261: 5257: 5247: 5212: 5208: 5198: 5171: 5167: 5157: 5124: 5120: 5114: 5089: 5085: 5059: 5055: 5049: 5019:(2): 87–90. 5016: 5012: 5006: 4969: 4965: 4955: 4920: 4916: 4906: 4871: 4867: 4857: 4822: 4818: 4808: 4773: 4769: 4734:(1): 91–95. 4731: 4727: 4683: 4679: 4669: 4652:11424/245594 4634: 4630: 4604: 4600: 4558: 4554: 4547: 4522: 4518: 4512: 4477: 4473: 4428:(1): 61–63. 4425: 4421: 4415: 4382: 4378: 4372: 4339: 4335: 4329: 4294: 4290: 4280: 4247: 4243: 4237: 4204: 4200: 4193: 4160: 4156: 4114: 4110: 4103: 4068: 4064: 4022: 4018: 4012: 4000:. Retrieved 3996:the original 3949: 3945: 3938: 3913: 3909: 3863: 3860:ISRN Surgery 3859: 3813: 3809: 3766: 3762: 3756: 3723: 3719: 3712: 3679: 3675: 3669: 3636: 3632: 3626: 3593: 3589: 3583: 3558: 3554: 3548: 3515: 3511: 3505: 3470: 3466: 3456: 3421: 3417: 3369: 3365: 3359: 3326: 3322: 3315: 3280: 3276: 3266: 3254:. Retrieved 3203: 3199: 3153: 3149: 3128:. Retrieved 3123: 3114: 3068: 3057: 3048: 3039: 3022: 3018: 3012: 3003: 2986: 2982: 2976: 2939: 2935: 2925: 2895: 2876: 2800: 2796: 2790: 2773: 2769: 2763: 2726: 2722: 2676: 2672: 2622: 2618: 2612: 2588:11573/576276 2571: 2567: 2561: 2549:. Retrieved 2539: 2506: 2502: 2466: 2460: 2448:. Retrieved 2406: 2300: 2272: 2237: 2233: 2177: 2173: 2166: 2154:. Retrieved 2150:the original 2022:. Retrieved 2011: 1999:. Retrieved 1876: 1870: 1846:(1): 24–32. 1843: 1839: 1829: 1774: 1753: 1744: 1740: 1736: 1733:invagination 1730: 1717: 1715: 1703: 1694: 1690: 1688: 1679: 1671: 1668:Epidemiology 1661: 1659: 1651: 1648: 1621: 1614: 1605:defecography 1595:, anorectal 1581:Defecography 1579: 1543: 1540: 1537: 1525: 1513: 1493: 1491: 1488: 1484: 1478:wall of the 1473: 1466: 1462:puborectalis 1455: 1451: 1448: 1440: 1421:constipation 1391: 1366:asymptomatic 1341: 1340: 1323: 1314: 1295: 1291:constipation 1280: 1271:Pruritus ani 1242: 1230: 1223: 1217:through the 1207: 1206: 1190: 1182: 1174: 1171: 1164: 1161: 1146: 1135: 1123:incontinence 1104: 1084: 1063: 1025: 1005: 997: 994: 986: 973: 972: 968:asymptomatic 964:Recto-rectal 963: 962: 953:Pelvic pain. 931:asymptomatic 928: 918:defecography 915: 898: 897: 885: 881: 880: 871: 867: 866: 862: 858: 857: 837: 826: 825: 821:laparoscopic 818: 809: 793: 789: 776: 773:Conservative 762: 754: 746: 742: 734: 721:loads (e.g. 699: 668: 664:dentate line 643:defecography 640: 629: 622: 587: 579: 552:constipation 532: 524: 520: 516:anal atresia 508: 504: 487: 469: 454: 437:Defecography 433: 424:barium enema 409: 397: 393: 389: 380: 336: 331: 330: 321: 320: 316:defecography 308: 282: 257: 252: 251: 241: 240: 235: 234: 225: 224: 194: 193: 188: 187: 178: 174: 168: 164: 158: 154: 149: 143: 139: 125: 106: 88: 86: 62: 58: 7338:Peritonitis 7100:Cholestasis 7078:Cholangitis 7021:Gallbladder 6909:Fatty liver 6829:Hematemesis 6811:GI bleeding 6617:Necrotizing 6546:Lymphocytic 6541:Collagenous 6536:Microscopic 6473:Steatorrhea 6374:Enteropathy 6220:Inlet patch 6142:Herpetiform 6127:Esophagitis 6031:MedlinePlus 4480:(1): 7–19. 2936:BMC Surgery 2640:10281/62853 2443:Marzouk D. 1787:section of 1722:Procidentia 1685:Terminology 1676:Pornography 1644:biofeedback 1370:rectal pain 1266:Rectal pain 1226:hemorrhoids 1186:hemorrhoids 1017:Enteroceles 903:procidentia 875:anastomotic 706:nulliparous 656:John Hunter 610:hyperplasia 540:degrees of 477:biofeedback 400:excoriation 230:hemorrhoids 41:Other names 7374:Categories 7330:Peritoneal 7308:Incisional 7229:Congenital 7173:Hereditary 7150:Pancreatic 7114:Haemobilia 6787:Hemorrhoid 6765:Anal canal 6703:Infectious 6691:Functional 6526:Ulcerative 6410:Duodenitis 6349:Gastrinoma 6053:Patient UK 6007:DiseasesDB 5921:14 October 5900:2020-08-31 5264:(4): 298. 4637:(6): e79. 4631:Pediatrics 3990:Donald K. 3866:: 652345. 3256:16 October 3248:Sherk SD. 3025:(1): 5–9. 2619:Dermatitis 2551:15 October 2156:13 October 2024:14 October 2016:Kiran RP. 2001:14 October 1822:References 1764:involving 1700:"Prolapse" 1591:, mucosal 1589:ultrasound 1560:granulomas 1509:histologic 1437:Prevalence 1398:defecation 1362:ulceration 1354:defecation 1350:anal canal 1287:defecation 974:Recto-anal 911:defecation 843:, or even 652:anal verge 606:Micrograph 445:enterocele 312:anal canal 246:ulceration 215:submucosal 203:defecation 123:symptoms. 7318:Richter's 7275:Spigelian 7270:Obturator 7260:Umbilical 7093:Ascending 7064:Bile duct 6897:Cirrhosis 6875:Hepatitis 6858:Accessory 6728:Proctitis 6579:Megacolon 6553:Dysentery 6463:Whipple's 6415:Jejunitis 6405:Enteritis 6292:Dyspepsia 6253:Gastritis 6186:Achalasia 6119:Esophagus 6042:eMedicine 4583:207073118 4272:205531685 4185:205531441 3910:Radiology 3104:ignored ( 3094:cite book 2729:(1): 72. 1745:suscipere 1741:susceptio 1718:procidere 1632:laxatives 1611:Treatment 1597:manometry 1528:stricture 1320:Treatment 1311:Diagnosis 1300:) of the 1101:Treatment 1081:Diagnosis 1069:Rectocele 1054:rectocele 1021:rectocele 768:Treatment 441:cystocele 372:Diagnosis 179:segmental 97:prolapsed 75:Specialty 7248:Indirect 7243:Inguinal 6977:Pyogenic 6922:Vascular 6698:Diarrhea 6676:Volvulus 6642:Vascular 6581: / 6570: / 6531:Ischemic 6498:Appendix 6388:Duodenum 6258:Atrophic 6132:Candidal 6047:med/3533 5874:28144208 5779:46533721 5681:14960517 5589:25736970 5581:12003716 5502:21971372 5467:10355182 5440:20965892 5391:21490861 5342:27955947 5334:22266488 5290:21727744 5239:15129312 5149:38880216 5141:12003718 5041:13503102 4998:21160895 4947:19861563 4661:12456946 4575:18642046 4539:18545877 4504:18512007 4450:19607242 4442:18512015 4407:20997835 4399:17115306 4356:14628157 4321:19175625 4264:19438880 4229:22097353 4221:24125518 4177:19486104 4131:24201396 4095:21140169 4039:18794001 3974:30806620 3966:23890098 3892:22577584 3838:20362023 3830:18654789 3791:25614599 3783:18074069 3740:22188470 3704:21774948 3696:15984985 3661:21148803 3653:15785903 3618:13534724 3497:36285327 3489:15898121 3448:20011408 3394:36592501 3351:25684257 3343:20497199 3307:35390136 3277:BJS Open 3086:22878278 3049:Whipworm 3031:19248418 2968:17194301 2825:21170092 2817:10647634 2755:22697798 2695:22041358 2649:21781642 2604:19519510 2596:16007353 2531:23227666 2523:17066611 2264:26599079 2194:25186920 1993:Kim DG. 1862:21603476 1795:See also 1777:proximal 1711:Prolapse 1636:psyllium 1634:such as 1476:anterior 1469:ischemia 1432:(rarely) 1425:diarrhea 1415:tenesmus 1388:Symptoms 1239:Symptoms 1138:resected 1111:psyllium 1050:anterior 978:perineum 948:tenesmus 925:Symptoms 797:perineum 786:Surgical 780:psyllium 723:Whipworm 719:helminth 627:defect. 583:Valsalva 574:diarrhea 556:tenesmus 416:neoplasm 169:internal 165:external 7289:Petit's 7265:Femoral 7168:Chronic 6982:Amoebic 6750:Anismus 6516:Colitis 6443:Coeliac 6420:Ileitis 6392:Jejunum 6245:Stomach 6149:Rupture 6001:D012005 5865:5179269 5822:2831853 5814:9876062 5771:9752869 5730:9462216 5721:1891593 5672:1773992 5632:2833491 5624:6092015 5546:7754839 5538:2460300 5431:3473720 5382:3075189 5281:3133995 5230:7177015 5190:2450805 5106:3536653 5068:1483723 5033:7636379 4989:2999680 4938:2853932 4898:8707093 4889:1383120 4849:5358578 4840:1553062 4800:8244113 4791:1374554 4748:7998576 4710:3678951 4701:1433454 4613:3536217 4495:2778725 4364:8408754 4312:2774156 4139:8094564 4086:3098348 3930:2294538 3883:3346690 3748:2148155 3610:1149581 3575:7638574 3540:9443258 3532:1425046 3439:2780198 3386:4064851 3298:8989040 3230:2612988 3221:1434461 3178:6337533 3170:9221859 3130:11 July 2995:4523440 2959:1785387 2782:2694021 2746:3444426 2255:7073406 1997:. ASCRS 1853:3096348 1816:Anismus 1783:of the 1569:colitis 1458:anismus 1402:Mucous 1259:Mucous 1197:anismus 1131:anismus 1013:anismus 1011:) like 801:abdomen 625:fascial 612:in the 473:anismus 377:History 326:sigmoid 265:anismus 211:mucosal 199:sigmoid 159:mucosal 7283:Lumbar 7253:Direct 7236:Hiatus 7216:Hernia 7068:Other 6834:Melena 6720:Rectum 6203:(GERD) 6036:001132 5990:176780 5896:. VICE 5872: 5862: 5820: 5812: 5777: 5769: 5728: 5718: 5679: 5669: 5630: 5622: 5587: 5579: 5544: 5536: 5500: 5465: 5438: 5428: 5389: 5379: 5340: 5332: 5288: 5278: 5237: 5227: 5188: 5147: 5139: 5104: 5066: 5039: 5031: 4996: 4986: 4945: 4935: 4896: 4886: 4847: 4837: 4798: 4788: 4746: 4708: 4698: 4659: 4611: 4581: 4573: 4537: 4502: 4492: 4448: 4440: 4405: 4397: 4362: 4354: 4319: 4309: 4270: 4262: 4227: 4219: 4183: 4175: 4137: 4129: 4093: 4083: 4037: 4002:8 July 3972: 3964: 3928: 3890: 3880: 3836: 3828: 3789: 3781: 3746: 3738: 3702: 3694: 3659: 3651: 3616: 3608: 3573: 3538: 3530: 3495: 3487: 3446: 3436: 3392: 3384: 3349: 3341: 3305: 3295: 3228: 3218: 3176: 3168: 3084: 3029: 2993: 2966: 2956: 2942:: 19. 2913: 2883: 2823: 2815: 2780: 2753: 2743: 2693: 2647: 2602: 2594: 2529: 2521: 2473: 2450:8 July 2413: 2313: 2262: 2252: 2192: 1883: 1860: 1850: 1789:rectum 1785:distal 1642:, and 1593:biopsy 1549:polyps 1346:rectum 1305:rectum 1302:distal 1215:mucosa 1212:rectal 1119:enemas 1109:(e.g. 999:cause 907:rectal 636:hernia 119:, and 93:rectum 7208:Other 7163:Acute 6914:MASLD 6867:Liver 6841:Lower 6824:Upper 6666:Ileus 6502:Colon 6396:Ileum 6211:(LPR) 6012:11189 5979:569.1 5964:K62.3 5818:S2CID 5775:S2CID 5628:S2CID 5585:S2CID 5542:S2CID 5338:S2CID 5145:S2CID 5037:S2CID 4579:S2CID 4446:S2CID 4403:S2CID 4360:S2CID 4268:S2CID 4225:S2CID 4181:S2CID 4135:S2CID 3970:S2CID 3834:S2CID 3787:S2CID 3744:S2CID 3700:S2CID 3657:S2CID 3614:S2CID 3536:S2CID 3493:S2CID 3390:S2CID 3347:S2CID 3174:S2CID 2821:S2CID 2600:S2CID 2527:S2CID 1781:lumen 1766:colon 1737:intus 1505:cysts 1502:mucin 1445:Cause 1277:Cause 991:Cause 847:with 758:lumen 597:Cause 591:edema 412:edema 95:have 6596:SCAD 5996:MeSH 5985:OMIM 5974:9-CM 5923:2012 5870:PMID 5810:PMID 5767:PMID 5726:PMID 5677:PMID 5620:PMID 5577:PMID 5534:PMID 5498:PMID 5463:PMID 5436:PMID 5387:PMID 5330:PMID 5286:PMID 5235:PMID 5186:PMID 5137:PMID 5102:PMID 5064:PMID 5029:PMID 4994:PMID 4943:PMID 4894:PMID 4845:PMID 4796:PMID 4744:PMID 4706:PMID 4657:PMID 4609:PMID 4571:PMID 4535:PMID 4500:PMID 4438:PMID 4395:PMID 4352:PMID 4317:PMID 4260:PMID 4217:PMID 4173:PMID 4127:PMID 4091:PMID 4035:PMID 4004:2012 3962:PMID 3926:PMID 3888:PMID 3864:2012 3826:PMID 3779:PMID 3736:PMID 3692:PMID 3649:PMID 3606:PMID 3571:PMID 3528:PMID 3485:PMID 3444:PMID 3382:PMID 3339:PMID 3303:PMID 3258:2012 3226:PMID 3166:PMID 3132:2021 3106:help 3082:PMID 3027:PMID 2991:PMID 2964:PMID 2911:ISBN 2881:ISBN 2813:PMID 2778:PMID 2751:PMID 2691:PMID 2645:PMID 2592:PMID 2553:2012 2519:PMID 2471:ISBN 2452:2012 2411:ISBN 2311:ISBN 2260:PMID 2238:2015 2190:PMID 2158:2012 2026:2012 2003:2012 1881:ISBN 1858:PMID 1695:labi 1691:pro- 1599:and 1348:and 1289:and 1219:anus 1044:and 728:COPD 658:and 213:and 101:anus 6902:PBC 6629:IBD 6563:IBS 5970:ICD 5955:ICD 5860:PMC 5852:doi 5802:doi 5757:doi 5716:PMC 5708:doi 5700:Gut 5667:PMC 5659:doi 5651:Gut 5612:doi 5569:doi 5526:doi 5490:doi 5426:PMC 5418:doi 5377:PMC 5369:doi 5320:doi 5276:PMC 5266:doi 5225:PMC 5217:doi 5176:doi 5129:doi 5094:doi 5021:doi 4984:PMC 4974:doi 4933:PMC 4925:doi 4884:PMC 4876:doi 4868:Gut 4835:PMC 4827:doi 4819:Gut 4786:PMC 4778:doi 4770:Gut 4736:doi 4732:164 4696:PMC 4688:doi 4680:Gut 4647:hdl 4639:doi 4635:110 4563:doi 4527:doi 4490:PMC 4482:doi 4430:doi 4387:doi 4344:doi 4307:PMC 4299:doi 4252:doi 4209:doi 4165:doi 4119:doi 4081:PMC 4073:doi 4027:doi 3954:doi 3918:doi 3914:174 3878:PMC 3868:doi 3818:doi 3771:doi 3728:doi 3684:doi 3680:100 3641:doi 3598:doi 3563:doi 3520:doi 3475:doi 3434:PMC 3426:doi 3374:doi 3331:doi 3293:PMC 3285:doi 3216:PMC 3208:doi 3200:Gut 3158:doi 3074:doi 2954:PMC 2944:doi 2907:294 2805:doi 2741:PMC 2731:doi 2681:doi 2635:hdl 2627:doi 2584:hdl 2576:doi 2511:doi 2307:143 2250:PMC 2242:doi 2182:doi 1848:PMC 1768:or 1325:EUA 1117:or 1113:), 1097:). 7376:: 7066:/ 6664:: 6645:: 6441:: 6056:: 6045:: 6034:: 6010:: 5999:: 5988:: 5977:: 5962:: 5959:10 5882:^ 5868:. 5858:. 5848:30 5846:. 5842:. 5830:^ 5816:. 5808:. 5798:85 5796:. 5773:. 5765:. 5753:85 5751:. 5747:. 5724:. 5714:. 5704:41 5702:. 5698:. 5675:. 5665:. 5655:53 5653:. 5649:. 5626:. 5618:. 5608:29 5606:. 5583:. 5575:. 5563:. 5540:. 5532:. 5522:33 5520:. 5496:. 5486:23 5484:. 5459:43 5457:. 5434:. 5424:. 5414:83 5412:. 5408:. 5385:. 5375:. 5363:. 5359:. 5336:. 5328:. 5316:54 5314:. 5310:. 5298:^ 5284:. 5274:. 5262:17 5260:. 5256:. 5233:. 5223:. 5213:47 5211:. 5207:. 5184:. 5172:33 5170:. 5166:. 5143:. 5135:. 5123:. 5100:. 5090:92 5088:. 5076:^ 5060:35 5058:. 5035:. 5027:. 5017:10 5015:. 4992:. 4982:. 4968:. 4964:. 4941:. 4931:. 4921:62 4919:. 4915:. 4892:. 4882:. 4872:38 4870:. 4866:. 4843:. 4833:. 4823:10 4821:. 4817:. 4794:. 4784:. 4774:34 4772:. 4768:. 4756:^ 4742:. 4730:. 4718:^ 4704:. 4694:. 4684:28 4682:. 4678:. 4655:. 4645:. 4633:. 4621:^ 4605:15 4603:. 4591:^ 4577:. 4569:. 4559:51 4557:. 4533:. 4523:12 4521:. 4498:. 4488:. 4478:12 4476:. 4472:. 4458:^ 4444:. 4436:. 4426:12 4424:. 4401:. 4393:. 4383:10 4381:. 4358:. 4350:. 4338:. 4315:. 4305:. 4295:11 4293:. 4289:. 4266:. 4258:. 4248:12 4246:. 4223:. 4215:. 4205:15 4203:. 4179:. 4171:. 4161:12 4159:. 4147:^ 4133:. 4125:. 4115:56 4113:. 4089:. 4079:. 4069:25 4067:. 4063:. 4047:^ 4033:. 4023:37 4021:. 3982:^ 3968:. 3960:. 3950:15 3948:. 3924:. 3912:. 3900:^ 3886:. 3876:. 3862:. 3858:. 3846:^ 3832:. 3824:. 3814:23 3812:. 3799:^ 3785:. 3777:. 3767:19 3765:. 3742:. 3734:. 3724:24 3722:. 3698:. 3690:. 3678:. 3655:. 3647:. 3637:48 3635:. 3612:. 3604:. 3594:18 3592:. 3569:. 3559:30 3557:. 3534:. 3526:. 3516:35 3514:. 3491:. 3483:. 3471:92 3469:. 3465:. 3442:. 3432:. 3422:21 3420:. 3416:. 3402:^ 3388:. 3380:. 3370:28 3368:. 3345:. 3337:. 3327:13 3325:. 3301:. 3291:. 3279:. 3275:. 3238:^ 3224:. 3214:. 3204:30 3202:. 3198:. 3186:^ 3172:. 3164:. 3154:40 3152:. 3140:^ 3122:. 3098:: 3096:}} 3092:{{ 3080:. 3066:. 3047:. 3023:92 3021:. 2987:74 2985:. 2962:. 2952:. 2938:. 2934:. 2909:. 2833:^ 2819:. 2811:. 2801:14 2799:. 2774:41 2772:. 2749:. 2739:. 2727:12 2725:. 2721:. 2703:^ 2689:. 2677:50 2675:. 2671:. 2657:^ 2643:. 2633:. 2623:22 2621:. 2598:. 2590:. 2582:. 2570:. 2525:. 2517:. 2507:95 2505:. 2485:^ 2425:^ 2325:^ 2309:. 2281:^ 2258:. 2248:. 2236:. 2232:. 2202:^ 2188:. 2178:17 2176:. 2034:^ 1895:^ 1856:. 1842:. 1838:. 1752:. 1702:. 1626:, 1583:, 1376:, 1372:, 1293:. 984:. 950:). 913:. 616:. 447:. 402:. 328:. 318:. 87:A 65:. 7102:/ 6775:/ 6594:/ 6590:/ 6504:) 6500:/ 6496:( 6398:) 6394:/ 6390:/ 6386:( 6093:e 6086:t 6079:v 5972:- 5957:- 5947:D 5925:. 5903:. 5876:. 5854:: 5824:. 5804:: 5781:. 5759:: 5732:. 5710:: 5683:. 5661:: 5634:. 5614:: 5591:. 5571:: 5565:5 5548:. 5528:: 5504:. 5492:: 5469:. 5442:. 5420:: 5393:. 5371:: 5365:2 5344:. 5322:: 5292:. 5268:: 5241:. 5219:: 5192:. 5178:: 5151:. 5131:: 5125:5 5108:. 5096:: 5070:. 5043:. 5023:: 5000:. 4976:: 4970:2 4949:. 4927:: 4900:. 4878:: 4851:. 4829:: 4802:. 4780:: 4750:. 4738:: 4712:. 4690:: 4663:. 4649:: 4641:: 4615:. 4585:. 4565:: 4541:. 4529:: 4506:. 4484:: 4452:. 4432:: 4409:. 4389:: 4366:. 4346:: 4340:7 4323:. 4301:: 4274:. 4254:: 4231:. 4211:: 4187:. 4167:: 4141:. 4121:: 4097:. 4075:: 4041:. 4029:: 4006:. 3976:. 3956:: 3932:. 3920:: 3894:. 3870:: 3840:. 3820:: 3793:. 3773:: 3750:. 3730:: 3706:. 3686:: 3663:. 3643:: 3620:. 3600:: 3577:. 3565:: 3542:. 3522:: 3499:. 3477:: 3450:. 3428:: 3396:. 3376:: 3353:. 3333:: 3309:. 3287:: 3281:6 3260:. 3232:. 3210:: 3180:. 3160:: 3134:. 3108:) 3088:. 3076:: 3033:. 2997:. 2970:. 2946:: 2940:6 2919:. 2889:. 2827:. 2807:: 2784:. 2757:. 2733:: 2697:. 2683:: 2651:. 2637:: 2629:: 2606:. 2586:: 2578:: 2572:9 2555:. 2533:. 2513:: 2479:. 2454:. 2419:. 2319:. 2266:. 2244:: 2196:. 2184:: 2160:. 2028:. 2005:. 1889:. 1864:. 1844:7 1417:) 1125:( 1076:. 1007:( 959:. 946:( 725:) 562:. 548:. 471:( 267:) 144:B 140:A 63:B 59:A 20:)

Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.

Index