the end of the operation, as described by Williams and Keighley in their book, “Surgery of the colon, rectum and anus.” This will improve continence and bowel frequency by providing for the storage of stool and by slowing colonic propulsion in the early postoperative months. Moreover, the patient who undergoes a perineal proctosigmoidectomy, e.g., an elderly multiparous female, is typically more likely to have weak sphincters and deficient sensation, with perineal descent and pudendal neuropathy. Finally, the anal sphincters are likely to be stretched during the surgical maneuvers and the stool tends to become more liquid after resec­tion of the distal large bowel, with a partial reduc­tion of the segmental motility of the sigmoid, whose functions include slowing the transit of the fecal stream. Some of the above-mentioned anatomical and physiological changes may be partly corrected by surgical maneuvers such as avoiding sphincter stretch and constructing a reservoir, whereas others cannot be prevented at all. Therefore, the operation is potentially harmful with respect to anal continence. However, in 30% of our patients continence improved after the Altemeier procedure, as the removal of the pro­lapsed rectum favors restoration of the recto-anal inhibitory reflex, which may be impaired by the presence of bulk, in turn causing soiling by per­manently stimulating the relaxation of the internal sphincter.