Classification of internal and external rectal prolapse

Physical examination has traditionally been, and continues to be, the mandatory initial step in the evaluation of patients with constipation or faecal incontinence. This is because the initial treatment decision and the necessity of further investigations of patients with pelvic floor dysfunction depend on primary clinical assessment of the patient [1]. Even if authors [2] found good correlation between clinical assessment and defecography in high-grade intussusceptions when studying subjects with defecatory difficulties, several reports in the nonradiologic literature have documented the relative insensitivity of the history and physical examination in diagnosing the cause of constipation and detecting pelvic organ prolapse [11, 3-6]. The common clinical physical examination tends to underestimate the degree of prolapse and may be able to diagnose only 30-40% of rectal prolapse [7]. Therefore, the precise preoperative diagnosis supplied by defecography can help in the selection of a rationale treatment programme, placing the patient into a treatment-defined group, determining the type of operation and giving objective evidence for the corrective scope and degree of operation.