Analysis of clinical features, anorectal manometry, and 3D perineal ultrasound in patients with internal rectal prolapse across different defecography grades

doi:10.3877/cma.j.issn.2095-3224.2026.03.008

Abstract

Abstract:

Objective

To observe the relationship between defecography grading and clinical symptom in patients with internal rectal prolapse (IRP), and to explore the clinical significance of anorectal manometry (ARM) and three-dimensional transperineal ultrasound (3D-TPU) in the comprehensive diagnostic evaluation of IRP.

Methods

A total of 246 patients with IRP who were admitted to the Department of Gastro-Colorectal and Anal Surgery, Daping Hospital, Army Medical University, from November 2023 to February 2025 and met the inclusion and exclusion criteria were prospectively enrolled. The collected data included the patients’ demographic characteristics, clinical symptom scores, constipation-related clinical scores, ARM and 3D-TPU parameters. After grouping patients with IRP according to defecography grading, the clinical manifestation characteristics of each group and the data of ARM and 3D-TPU were analyzed.

Results

A total of 246 IRP patients were enrolled in this study, including 213 females (86.59%) and 33 males (13.41%), with an average age of (53.12±11.76) years. A total of 246 patients completed defecography and ARM examinations, while 70 patients underwent 3D-TPU examination. The higher the defecography grading, the more severe the clinical symptoms in patients. Among patients with defecography grades Ⅰ~Ⅱ, those with concurrent dyssynergic defecation and increased bladder neck mobility had a significantly higher obstructive defecation syndrome (ODS) score than those without either of these abnormalities.

Conclusion

The higher the defecography grading in patients with IRP, the more severe their clinical symptoms; patients with low-grade but significant symptoms require multidimensional assessment to identify the underlying cause. ARM and 3D-TPU can provide complementary information for IRP patients from functional and morphological aspects, offering a more reliable objective basis for comprehensive clinical assessment and individualized treatment.

Key words: Internal rectal prolapse, Defecography, Anorectal manometry, Three-dimensional transperineal ultrasound

Qing Li, Xingjie Xie, Weidong Tong, Yansen Huang, Fan Li, Huichao Zheng, Guodong Xiao, Li Wang, Bin Huang, Zhigang Ke. Analysis of clinical features, anorectal manometry, and 3D perineal ultrasound in patients with internal rectal prolapse across different defecography grades[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2026, 15(03): 256-262.

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References 25

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疾病名称	分级	放射学特征
直肠内脱垂	Ⅰ级（高位直肠）	下垂不超过直肠膨出的近端
	Ⅱ级（低位直肠）	下垂至直肠膨出的水平，但未到达括约肌/肛管
	Ⅲ级（高位肛门）	下垂至括约肌/肛管
	Ⅳ级（低位肛门）	下垂进入括约肌/肛管

疾病名称	分级	放射学特征
直肠内脱垂	Ⅰ级（高位直肠）	下垂不超过直肠膨出的近端
	Ⅱ级（低位直肠）	下垂至直肠膨出的水平，但未到达括约肌/肛管
	Ⅲ级（高位肛门）	下垂至括约肌/肛管
	Ⅳ级（低位肛门）	下垂进入括约肌/肛管

临床评分	Ⅰ~Ⅱ级（n=80）	Ⅲ~Ⅳ级（n=166）	检验值	P值
Wexner	11.00（9.00，14.00）	12.5（9.00，16.00）	Z=−1.521	0.129
ODS	9.00（6.00，14.00）	12.00（7.00，16.00）	Z=−1.942	0.052
PAC-QOL（分）	42.52±18.62	48.10±20.80	t=−2.035	0.043
担心忧虑	16.00（10.00，22.25）	18.00（10.00，26.75）	Z=−1.549	0.121
社会心理	7.00（3.00，11.25）	9.00（4.00，14.00）	Z=−1.647	0.100
躯体症状	6.00（4.00，8.00）	7.00（5.00，10.00）	Z=−2.224	0.026
满意度	12.00（9.00，14.00）	13.00（10.00，15.00）	Z=−1.354	0.176
SAS	40.00（35.75，46.00）	43.00（36.25，49.00）	Z=−2.385	0.017

临床评分	Ⅰ~Ⅱ级（n=80）	Ⅲ~Ⅳ级（n=166）	检验值	P值
Wexner	11.00（9.00，14.00）	12.5（9.00，16.00）	Z=−1.521	0.129
ODS	9.00（6.00，14.00）	12.00（7.00，16.00）	Z=−1.942	0.052
PAC-QOL（分）	42.52±18.62	48.10±20.80	t=−2.035	0.043
担心忧虑	16.00（10.00，22.25）	18.00（10.00，26.75）	Z=−1.549	0.121
社会心理	7.00（3.00，11.25）	9.00（4.00，14.00）	Z=−1.647	0.100
躯体症状	6.00（4.00，8.00）	7.00（5.00，10.00）	Z=−2.224	0.026
满意度	12.00（9.00，14.00）	13.00（10.00，15.00）	Z=−1.354	0.176
SAS	40.00（35.75，46.00）	43.00（36.25，49.00）	Z=−2.385	0.017

测压指标	Ⅰ~Ⅱ级（n=80）	Ⅲ~Ⅳ级（n=166）	检验值	P值
ASRP（mmHg）	56.69±24.69	58.80±22.46	t=−0.671	0.505
HPZ（cm）	3.00±1.02	3.20±0.95	t=−1.485	0.137
MSP（mmHg）	171.00（127.50，214.50）	177.00（130.00，227.00）	Z=−0.612	0.544
DSS（s）	11.30（8.30，19.70）	11.10（7.50，21.60）	Z=−0.158	0.872
RP（mmHg）	59.00（46.00，75.25）	60.00（45.00，81.00）	Z=−0.352	0.727
AR	0.14（0.05，0.30）	0.17（0.05，0.33）	Z=−0.531	0.595
FSV（mL）	43.00（36.00，53.50）	42.00（30.00，52.00）	Z=−0.874	0.385
DSV（mL）	68.50（56.00，91.25）	71.00（52.50，90.00）	Z=−0.681	0.496
MTV（mL）	118.00（99.00，152.00）	122.00（94.00，147.00）	Z=−0.173	0.862

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