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Internal rectal intussusception (rectal intussusception, internal intussusception, internal rectal prolapse, occult rectal prolapse, internal rectal procidentia and rectal invagination) is a medical condition defined as a funnel shaped infolding of the rectal wall that can occur during. Watch free midget multiple creampie videos at Heavy-R, a completely free porn tube offering the world's most hardcore porn videos. New videos about midget multiple creampie added today!. 3 year ago XXXKinky sloppy, anal, francais, foursome · chilean, slut, compilation, foot fetish 3 year ago XXXKinky chilean, slut, compilation, foot fetish · college, nude, jail, big nipples 3 year ago XXXKinky college, nude, jail, big nipples; 1 year ago OverThumbs; blowjob, redhead, threesome 00 2.
Rectal prolapse often used to mean complete rectal prolapse external rectal prolapsewhere the rectal walls have prolapsed to a degree where they protrude out the anus and are visible outside the body. Rectal prolapse may occur without any symptoms, but depending upon the nature of the prolapse there may Midget anal internal mucous discharge mucus coming from the anusrectal bleedingdegrees of fecal incontinence and obstructed defecation symptoms.
Rectal prolapse is generally more common in elderly women, although it may occur at any age and in both sexes. It is very rarely life-threatening, but the symptoms can be debilitating if left untreated. Internal prolapses are traditionally harder to treat and surgery may not be suitable for many patients. 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. External complete rectal prolapse rectal procidentia, full thickness rectal prolapse, external rectal prolapse is a full thickness, circumferential, true intussusception of the rectal wall which protrudes from the anus and is visible externally. Internal rectal intussusception occult rectal prolapse, internal procidentia can be defined as a funnel shaped infolding of the rectal or lower sigmoid wall that can occur during defecation.
Mucosal prolapse 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 hemorrhoids piles. Internal Midget anal internal prolapse rectal internal mucosal prolapse, RIMP refers to prolapse of the mucosal layer Midget anal internal the rectal wall which does not protrude externally.
Midget anal internal is some controversy surrounding this condition as to its relationship with hemorrhoidal disease, or whether it is a separate entity.
Solitary rectal ulcer syndrome SRUS, solitary rectal ulcer, SRU occurs with internal rectal intussusception and is part of the of rectal prolapse conditions.
Mucosal prolapse syndrome MPS is recognized by some. It includes solitary rectal ulcer syndrome, rectal prolapse, proctitis cystica profunda, and inflammatory polyps. 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:
Midget anal internal internal mucosal prolapse has been graded according to the level of descent of the intussusceptum, which was predictive of symptom severity: The height of intussusception from the anal canal is usually estimated by defecography.
Recto-rectal high intussusception intra-rectal intussusception is Midget anal internal the intussusception starts in the rectum, does not protrude into the anal canal, but stays within the rectum. The intussuscipiens includes rectal lumen distal to the intussusceptum only. These are usually intussusceptions that originate in Midget anal internal upper rectum or lower sigmoid.
Recto-anal low intussusception intra-anal intussusception is where the intussusception starts in the rectum and protrudes into the anal canal i. An Anatomico-Functional Classification of internal rectal intussusception has been described,  with the argument that other factors apart from the
Midget anal internal of intussusception above the anal canal appear to be important to predict symptomology.
The parameters of this classification are anatomic descent, diameter of intussuscepted bowel, associated rectal hyposensitivity and associated delayed colonic transit:.
Patients may have associated gynecological conditions which may
Midget anal internal multidisciplinary Midget anal internal. Fecal incontinence may also influence the choice of management. Rectal prolapse may be confused easily with prolapsing hemorrhoids. In full thickness rectal prolapse, these folds circumferential. In mucosal prolapse, these folds are radially. Furthermore, in rectal Midget anal internal, there is a sulcus present between the prolapsed bowel and the anal verge, whereas in hemorrhoidal disease there is no sulcus.
The prolapse may be obvious, or it may require straining and squatting to produce it. The perianal skin may be macerated softening and whitening of skin that is kept constantly wet and show excoriation. In addition, patients are frequently elderly and therefore have increased incidence of colorectal cancer.
Full length colonoscopy is usually carried out in adults prior to any surgical intervention. This investigation is used to diagnose internal intussusception, or demonstrate a suspected external prolapse that could not be produced during the examination.
Colonic transit studies
Midget anal internal be used to rule out colonic inertia if there is a history of severe constipation. This investigation objectively documents the functional status of the Midget anal internal. However, the clinical significance of the findings are disputed by some.
STARRand these patients may benefit from post-operative biofeedback therapy. Decreased squeeze and resting pressures are usually the findings, and this may predate the development of the prolapse. 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.
The appearance is of a reddened, proboscis-like object through the anal Patients find the condition embarrassing. The true incidence of rectal prolapse is unknown, but it is thought to be uncommon. As most sufferers are elderly, the condition is generally under-reported.
It is rare in men over 45 and in women under
Midget anal internal Anatomical differences such as the wider pelvic outlet in females may explain the skewed gender distribution. Associated conditions, especially in younger patients include autism, developmental delay syndromes and psychiatric conditions requiring several medications.
Initially, the mass may protrude through the anal canal Midget anal internal during defecation and straining, and spontaneously return afterwards. Later, the mass may have to be pushed back in
Midget anal internal defecation. This may progress to a chronically prolapsed and severe condition, defined as spontaneous prolapse that is difficult to keep Midget anal internal, and occurs with walking, prolonged standing,  coughing or sneezing Valsalva maneuvers.
If the prolapse becomes trapped externally outside the anal sphincters, it may become strangulated and there is a risk of perforation.
The precise cause is unknown,    and has been much debated. 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. Shortly after the invention of defecographyIn Broden and Snellman used cinedefecography to show that rectal prolapse begins as a circumferential intussusception of the rectum, Midget anal internal  which slowly increases over time.
Since most patients with rectal prolapse have a long history of constipation,  it is thought that prolonged, excessive and repetitive straining during defecation
Midget anal internal predispose to rectal prolapse.
Some authors question whether these are the cause, or secondary to the prolapse. Some authors suggest that pudendal nerve damage the cause for pelvic floor and anal sphincter weakening, and may be the underlying cause of a spectrum of pelvic floor disorders. Sphincter function in rectal prolapse is almost always reduced.
Alternatively, the intussuscepting rectum may lead to chronic stimulation the rectoanal inhibitory reflex RAIR - contraction of the external anal sphincter in response to stool in the rectum.
The RAIR was shown
Midget anal internal be absent or blunted. Squeeze maximum voluntary contraction pressures may be effected as Midget anal internal as the resting tone.
This is most likely a denervation injury to the external anal sphincter. The assumed mechanism of fecal incontinence 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.
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 Midget anal internal itself may mechanically obstruct the rectoanal lumencreating a blockage that straining, anismus and colonic dysmotility exacerbate. 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 external rectal prolapse. Surgery is thought to be the only option to potentially cure a complete rectal prolapse. Dietary adjustments, including increasing dietary fiber may be beneficial to reduce constipation, and thereby reduce straining. 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. 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 incision around the anus and perineum the area between the genitals and the anus.
Procedures for rectal prolapse may involve fixation of the bowel rectopexyor resection a portion removedor both. abdominal approach carries a small risk of impotence in males e. Laparoscopic procedures Recovery time following laparoscopic surgery is shorter and less painful than following traditional abdominal surgery. The perineal approach generally results in less post-operative pain Midget anal internal complications, and a reduced length of hospital stay.
These procedures generally carry a higher recurrence rate and poorer functional outcome. 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. 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 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 muscle layer that is left is plicated folded and placed as a buttress above the pelvic floor.
This procedure can be carried out under local anaesthetic. After reduction of the prolapse, a subcutaneous suture a stich under the skin or other material is placed encircling the anus, which is then made taut to further prolapse. Complications include breakage of the encirclement material, fecal impaction, sepsis, and erosion into the skin or anal canal.
Recurrence rates are higher
Midget anal internal the other perineal procedures. This Midget anal internal 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 Internal rectal intussusception rectal intussusception, internal intussusception, internal rectal prolapse, occult rectal prolapse, internal rectal procidentia rectal invagination is a medical condition defined as a funnel shaped infolding of the rectal wall that can occur during defecation.
This phenomenon was first described in the late s when defecography was first developed and became widespread. Internal intussusception may be asymptomaticbut common symptoms include: Recto-rectal intussusceptions may be asymptomaticapart from mild obstructed defecation. Recto-anal intussusceptions commonly give more severe symptoms of straining, incomplete evacuation, need for digital evacuation of stool, need for support of the perineum during defecation, urgency, frequency or intermittent fecal incontinence.
Rectal prolapse often used to mean complete rectal prolapse external rectal prolapse , where the rectal walls have prolapsed to a degree where they protrude out the anus and are visible outside the body. Rectal prolapse may occur without any symptoms, but depending upon the nature of the prolapse there may be mucous discharge mucus coming from the anus , rectal bleeding , degrees of fecal incontinence and obstructed defecation symptoms. Rectal prolapse is generally more common in elderly women, although it may occur at any age and in both sexes.
It is very rarely life-threatening, but the symptoms can be debilitating if left untreated. Internal prolapses are traditionally harder to treat and surgery may not be suitable for many patients.
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. External complete rectal prolapse rectal procidentia, full thickness rectal prolapse, external rectal prolapse is a full thickness, circumferential, true intussusception of the rectal wall which protrudes from the anus and is visible externally.
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Midget anal internalSRUS is not a medically serious disease, it can be the cause of significantly reduced quality of life for patients. STARR was compared with biofeedback and found to be more effective at reducing symptoms and improving quality of life. Ulceration may persist even when symptoms resolve. The goal of Perineal rectosigmoidectomy is to resect, or remove, the redundant bowel. Trauma from hard stools may also contribute.
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