Medical history A good medical history is probably the most important single study. The patient will tell you if they had to strain to have a bowel movement. Patients will also be able to tell if they have intermittent, relatively normal bowel movements. If a patient has a history of prolonged catheterization for difficult evacuation, then performing a colectomy should be chosen carefully. Constipation may be more severe after transabdominal rectal suspension in patients with laxative support. Therefore, if colonic motility is determined, subtotal colectomy with ileorectal anastomosis may be an option. Similarly, a symptomatic third-degree sigmoid hernia with normal colonic transmission is identified, and simultaneous sigmoid and colonic resection may be an option. Rectal resection fixation should be of note. Prolapse fixation and sigmoidectomy anastomosis may control prolapse or result in improvement of constipation, but if the left hemicolectomy performed is too long, it may carry the risk of acute incontinence. Most patients with rectal prolapse have a relatively open anus, which is associated with weak support and reduced compression. Therefore, rectal resection fixation will be offered to patients who have a clear history of preoperative constipation without the presence of sphincter weakening factors. Moreover, clinical examination and anal canal manometry will provide satisfactory findings. Thus, in patients with rectal prolapse, the significance of preoperative studies is not only to determine the transmission function of the colon and diminished rectal evacuation, but also to assess whether the sphincter is strong enough to resist the consequences of postcolonic resection. Although this is an important warning sign, the data seem to suggest that there is no deleterious effect of injurious rectal resection fixation on the support or anal canal pressure compared with rectal fixation alone. Moreover, the incidence of persistent anal incontinence caused by rectal resection fixation was not higher compared with rectal fixation alone (Table 2). In fact, the incidence of postoperative constipation was even less. Two prospective randomized studies showed that proctocolectomy fixation preserved better function than rectal fixation alone. Specifically, Luukkonen and co-workers prospectively randomized 30 patients to undergo transabdominal rectal fixation with sigmoid resection versus rectal fixation alone. Constipation disappeared in three patients after rectal resection and fixation, compared with two patients after rectal fixation alone. Five other patients had worse constipation after rectal fixation alone, and one of them required colectomy. The authors noted that although surgery does not significantly alter the number of sigmoid transmissions and may also increase postoperative morbidity, sigmoidectomy does eliminate postoperative constipation and is particularly less likely to cause obstruction. In a similar study, Mckee and associates prospectively divided 18 patients with total rectal prolapse into a sigmoidectomy group and an unresected group. Using postoperative colonic transmission studies, they found that significantly more patients had delayed postoperative transmission in patients who underwent rectal fixation alone compared with those who underwent sigmoid resection with rectal fixation. Physiological studies of the anorectum may provide some answers to this difference. Patients who underwent rectal fixation alone had a significantly higher rectal compliance than those who underwent rectal resection and fixation. They suggest that the redundant sigmoid colon may delay the transmission of information about the contents of the bowel and cause kinking at the site of the sigmoid-rectal junction.