Nat Wijffels

Publications (2)5.85 Total impact

• Article: What are the symptoms of internal rectal prolapse?

  Nat Wijffels, Om Jones, C Cunningham, Wa Bemelman, I Lindsey
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  ABSTRACT: Aim:  Although high grade internal rectal prolapse is believed to cause functional symptoms such as obstructed defaecation, little has been published on the exact distribution and frequency of symptoms. The aim of this study was to identify the most common symptoms of patients with high grade internal rectal prolapse. Method:  Patients were diagnosed with high grade prolapse (grade 3 and 4) on proctography using the Oxford Rectal Prolapse Grade. Information from a prospectively collected database was supplemented by retrospective case note review. Results:  Ninety patients (96% female) were included for analysis. Faecal incontinence (55%) was the most common symptom at presentation. Symptoms related to obstructed defaecation syndrome were the next most common, including incomplete evacuation (46%), straining (34%), repetitive toilet visits (33%) and digital assistance (33%). Conclusion:  A variety of symptoms may be caused by high grade internal rectal prolapse Although symptoms of obstructed defaecation were frequent, urge faecal incontinence was the most common. © 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.
  Colorectal Disease 07/2012; · 2.93 Impact Factor
• Article: Enterocoele is a marker of severe pelvic floor weakness.

  M E D Jarrett, N A T Wijffels, A Slater, C Cunningham, I Lindsey
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  ABSTRACT: The aim was to evaluate the relationship between the presence of an enterocoele and grade of rectal prolapse (RP). Defaecating proctograms of consecutive patients presenting to the Oxford Pelvic Floor Clinic between January 2004 and November 2008 were analysed. Patients were included if they had full thickness internal (grades 1-4 prolapse) or external RP (grade 5 prolapse). All those included were analysed with regards to the presence of an enterocoele. Three hundred and seventy-one patients [322 (87%) women and 49 (23%) men] were found to have a degree of RP. One out of eight (12.5%) patients with grade 1 RP, 10/42 (18.5%) with grade 2 RP, 34/125 (27%) with grade 3 RP, 62/135 (46%) with grade 4 RP and 23/49 (47%) with grade 5 full thickness external RP had an enterocoele present. This was a statistically significant trend (Pearson chi(2) test P < 0.0002). There was a significantly higher proportion of enterocoeles in women [125/322 (39%) than in men (5/49 (10%)] (P < 0.0001) and a higher likelihood of having an enterocoele with advancing age (P < 0.0001). Within the study, there was no significant difference in the proportion of nulliparous and parous women with enterocoeles (P = 0.8); there were a significantly higher proportion of enterocoeles in hysterectomized women (P = 0.015). Enterocoele is increasingly seen with advancing RP severity. This suggests that the two findings are part of the same pelvic floor process. These data support the hypothesis that enterocoele is a marker of severe pelvic floor weakness. Enterocoele is seen more frequently in females particularly after hysterectomy.
  Colorectal Disease 09/2009; 12(7 Online):e158-62. · 2.93 Impact Factor