Patients often present with complaints of rectal prolapse or disordered gastroin­testinal elimination, either constipation or fecal incontinence. They may describe protrusion of anorectal tissue past the anal verge, which may exist alone or in com­bination with symptoms of dysfunctional bowel elimination. Patients complaining of constipation symptoms often describe excessive or prolonged straining with bowel movements, pain with defecation, or incomplete evacuation of the rectum. A careful history and physical examination in addition to defecography is helpful in distinguishing obstructive defecation from slow-transit constipation. A Sitzmark study is useful in evaluating intestinal transit and will help to determine whether a partial or subtotal colectomy should be performed in conjunction with rectopexy. For patients who complain of involuntary loss of bowel contents, several diagnos­tic modalities are useful for evaluation. These include endoanal ultrasound and anorectal manometry. Endoanal ultrasound is the primary modality because it can accurately determine defects in the internal and external anal sphincter as well as anal canal length. Anorectal manometry measures resting and squeezing pressures of the anal canal and can also provide important information regarding anorectal innervation [12].

diagnosing pelvic organ prolapse than physical examination alone and is useful for combined surgical planning. These patients require the collaboration of multiple surgical specialists [14].