Rectal intussusception: Medical management and timing of the decision to operate

Rectal Intussusception (RI) occurs when the rectal wall telescopes distally without prolapse past the anal verge during defecation and occurs as the result of abnormal rectal wall biomechanics. Symptoms are variable though ¾ of patients with high grade intussusception report straining, incomplete emptying and the need for manual assistance during evacuation. The diagnosis of RI requires a comprehensive clinical history, physical exam and dynamic imaging of evacuation with MR or fluoroscopic defecography. Phenotypic grading is important as low-grade, non-obstructing RI may not significantly contribute to symptoms and outcomes following surgery in this group is poor. Initial management should focus on improving stool form and evacuatory dynamics in conjunction with biofeedback if there associated dyssynergia. Surgery should only be considered in those patients with high-grade intussusception and symptoms resistant to medical therapies after appropriate counselling regarding the risks and benefits of intervention.