[Prolapse and incontinence].
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Complete prolapse or procidentia of the rectum describes the extrusion of the entire thickness of the rectal wall through the anus. A number of factors have been alleged to be important in the production of procidentia; at present stress is placed on the concept of intussuception. A large number of operative procedures, designed to correct this condition, reflect the unsatisfactory nature of the results hitherto achieved. The author's personal preference is a transperitoneal approach whenever feasible (Well's Procedure) with sacro-fixation. If a perineal approach is unavoidable for medical reasons the Thiersch-Procedure in Stelzner's modification (placement of the ring below the pelvic floor muscles) yields acceptable results. In seemingly hopeless recurrent cases, the procedure of Sarafoff can prove to be successful.
Real-time transperineal sonography has enhanced the appreciation of morphology and dynamics of the pelvic floor. Standard images are obtained from longitudinal and axial planes by placing the transducer between the vagina and rectum. This fast, effective, noninvasive and inexpensive examination represents the preferred initial diagnostic imaging tool for women with pelvic floor dysfunctions, such as prolapse and incontinence.
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