Overactivity of the anal sphincter during defecation causes the patient to require more effort to expel stool. The prolapse may be obvious, or it may require straining and squatting to produce it. If the prolapse becomes trapped externally outside the anal sphincters, it may become strangulated and there is a risk of perforation. This phenomenon was first described in the late s when defecography was first developed and became widespread. However, the area may of ulceration may be closer to the anus, deeper inside, or on the lateral or posterior rectal walls. Non surgical measures to treat internal intussusception include pelvic floor retraining,  a bulking agent e. Redundant rectal and sigmoid wall is removed and the new edge of colon is reconnected anastomosed with the anal canal with stitches or staples. Some authors suggest that pudendal nerve damage is the cause for pelvic floor and anal sphincter weakening, and may be the underlying cause of a spectrum of pelvic floor disorders. The perineal approach generally results in less post-operative pain and complications, and a reduced length of hospital stay.
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