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International Urogynecology Journal

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15.12.2015 | Original Article

The prevalence of abnormal posterior compartment anatomy and its association with obstructed defecation symptoms in urogynecological patients

verfasst von: Rodrigo Guzman Rojas, Ixora Kamisan Atan, Ka Lai Shek, Hans Peter Dietz

Erschienen in: International Urogynecology Journal | Ausgabe 6/2016

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Abstract

Introduction and hypothesis

Symptoms of obstructive defecation (OD) are common in women. Transperineal ultrasound (TPUS) has been used for the evaluation of defecatory disorders. The aim of our study was to determine the overall prevalence of anatomical abnormalities of the posterior compartment and their correlations with OD in women seen in a tertiary urogynecology clinic.

Methods

This is a retrospective study on 750 women seen at a tertiary urogynecological unit who had undergone a standardized interview, clinical examination, and 4D TPUS. Univariate and multivariate logistic regression analyses were undertaken to study the association between examination findings and symptoms of OD. This study was approved by the local human research ethics committee (Nepean Blue Mountains Local Health District Human Research Ethics Committee, IRB approval no. 13–16).

Results

The datasets of 719 women were analyzed. Mean age was 56.1 (18.4–87.6) years. Ninety-seven patients (13 %) reported fecal incontinence, 190 (26 %) constipation, and 461 (64 %) symptoms of OD. On examination, 405 women (56 %) were diagnosed with significant posterior compartment prolapse (POP-Q ≥ stage 2), which was associated with symptoms of OD (p < 0.0001). On ultrasound, 103 (14 %) patients had an enterocele, 382 (53 %) a true rectocele and 31 (4.3 %) had rectal intussusception. On multivariate analysis true rectocele (p = 0.003) and rectal intussusception (p = 0.004) remained significantly associated with symptoms of OD.

Conclusion

Both symptoms of OD and anatomical abnormalities of the posterior compartment are highly prevalent in urogynecological patients. Ultrasound findings of a true rectocele and rectal intussusception are significantly associated with obstructed defecation.

Everhart JE, Go VLW, Johannes RS, Fitzsimmons SC, Roth HP, White LR (1989) A longitudinal survey of self-reported bowel habits in the United States. Dig Dis Sci 34(8):1153–1162CrossRefPubMed

Sonnenberg A, Koch TR (1989) Physician visits in the United States for constipation: 1958 to 1986. Dig Dis Sci 34(4):606–611CrossRefPubMed

Surrenti E, Rath DM, Pemberton JH, Camilleri M (1995) Audit of constipation in a tertiary referral gastroenterology practice. Am J Gastroenterol 90(9):1471–1475PubMed

Zbar A, Lienemann A, Fritsch H, Beer-Gabel M, Pescatori M (2003) Rectocele: pathogenesis and surgical management. Int J Colorectal Dis 18(5):369–384CrossRefPubMed

Spence-Jones C, Kamm MA, Henry MM, Hudson C (1994) Bowel dysfunction: a pathogenic factor in uterovaginal prolapse and urinary stress incontinence. BJOG Int J Obstet Gynaecol 101(2):147–152CrossRef

Andromanakos N, Skandalakis P, Troupis T, Filippou D (2006) Constipation of anorectal outlet obstruction: pathophysiology, evaluation and management. J Gastroenterol Hepatol 21(4):638–646CrossRefPubMed

Karlbom U, Påhlman L, Nilsson S, Graf W (1995) Relationships between defecographic findings, rectal emptying, and colonic transit time in constipated patients. Gut 36(6):907–912CrossRefPubMedPubMedCentral

Pannu HK, Kaufman HS, Cundiff GW, Genadry R, Bluemke DA, Fishman EK (2000) Dynamic MR imaging of pelvic organ prolapse: spectrum of abnormalities. Radiographics 20(6):1567–1582CrossRefPubMed

Hutchinson R, Mostafa A, Grant E, Smith N, Deen K, Harding L, Kumar MD (1993) Scintigraphic defecography: quantitative and dynamic assessment of anorectal function. Dis Colon Rectum 36(12):1132–1138CrossRefPubMed

10.

Dietz HP, Steensma AB (2005) Posterior compartment prolapse on two- dimensional and three- dimensional pelvic floor ultrasound: the distinction between true rectocele, perineal hypermobility and enterocele. Ultrasound Obstet Gynecol 26:73–77CrossRefPubMed

11.

Rodrigo N, Shek KL, Dietz HP (2011) Rectal intussusception is associated with abnormal levator ani muscle structure and morphometry. Tech Coloproctol 15(1):39–43. doi:10.1007/s10151-010-0657-1 CrossRefPubMed

12.

Perniola G, Shek C, Chong CC, Chew S, Cartmill J, Dietz HP (2008) Defecation proctography and translabial ultrasound in the investigation of defecatory disorders. Ultrasound Obstet Gynecol 31(5):567–571. doi:10.1002/uog.5337 CrossRefPubMed

13.

Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17CrossRefPubMed

14.

Dietz HP (2010) Pelvic floor ultrasound: a review. Am J Obstet Gynecol 202(4):321–334. doi:10.1016/j.ajog.2009.08.018 CrossRefPubMed

15.

Dietz HP, Haylen BT, Broome J (2001) Ultrasound in the quantification of female pelvic organ prolapse. Ultrasound Obstet Gynecol 18(5):511–514CrossRefPubMed

16.

Dietz HP, Korda A (2005) Which bowel symptoms are most strongly associated with a true rectocele? Aust NZ J Obstet Gynaecol 45:505–508CrossRef

17.

Dietz H, Bernardo M, Kirby A, Shek K (2011) Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound. Int Urogynecol J 22(6):699–704CrossRefPubMed

18.

Dietz H, Beer-Gabel M (2012) Ultrasound in the investigation of posterior compartment vaginal prolapse and obstructed defecation. Ultrasound Obstet Gynecol 40(1):14–27CrossRefPubMed

19.

Steensma AB, Oom DM, Burger CW, Schouten WR (2010) Assessment of posterior compartment prolapse: a comparison of evacuation proctography and 3D transperineal ultrasound. Colorectal Dis 12(6):533–539CrossRefPubMed

20.

Beer-Gabel M, Teshler M, Schechtman E, Zbar AP (2004) Dynamic transperineal ultrasound vs. defecography in patients with evacuatory difficulty: a pilot study. Int J Colorectal Dis 19(1):60–67CrossRefPubMed

21.

Grasso R, Piciucchi S, Quattrocchi C, Sammarra M, Ripetti V, Beomonte Zobel B (2007) Posterior pelvic floor disorders: a prospective comparison using introital ultrasound and colpocystodefecography. Ultrasound Obstet Gynecol 30(1):86–94CrossRefPubMed

22.

Beer-Gabel M, Assoulin Y, Amitai M, Bardan E (2008) A comparison of dynamic transperineal ultrasound (DTP-US) with dynamic evacuation proctography (DEP) in the diagnosis of cul de sac hernia (enterocele) in patients with evacuatory dysfunction. Int J Colorectal Dis 23:513–519CrossRefPubMed

23.

Vangruting IT, Stankiewic R, Sultan A (2015) Accuracy of evacuation proctogram, MRI and ultrasound for detecting posterior compartment disorders. Int Urogynecol J 26(S1):S69–S70

24.

Dietz HP, Steensma AB (2006) The prevalence of major abnormalities of the levator ani in urogynaecological patients. BJOG 113(2):225–230. doi:10.1111/j.1471-0528.2006.00819.x CrossRefPubMed

25.

Guzmán Rojas R, Shek K, Langer S, Dietz H (2013) The prevalence of anal sphincter injury in primiparous women. Ultrasound Obstet Gynecol 42(4):461–466PubMed

26.

Dietz HP, Rojas RG, Shek KL (2014) Postprocessing of pelvic floor ultrasound data: how repeatable is it? Aust N Z J Obstet Gynaecol 54(6):553–557CrossRefPubMed

27.

Richardson AC (1995) The anatomic defects in rectocele techniques and enterocele. Female Pelvic Med Reconstruct Surg 1(4):214–221

28.

Guzman Rojas R, Kamisan Atan I, Shek KL, Dietz HP (2015) Defect-specific rectocele repair: medium-term anatomical, functional and subjective outcomes. Aust N Z J Obstet Gynaecol 55:487–492. doi:10.1111/ajo.12347 CrossRefPubMed

29.

Tan L, Shek KL, Atan IK, Rojas RG, Dietz HP (2014) The repeatability of sonographic measures of functional pelvic floor anatomy. Int Urogynecol J 26:1667–1672CrossRef

30.

Siafarikas F, Stær-Jensen J, Braekken I, Bø K, Engh ME (2013) Learning process for performing and analyzing 3D/4D transperineal ultrasound imaging and interobserver reliability study. Ultrasound Obstet Gynecol 41(3):312–317CrossRefPubMed

Titel: The prevalence of abnormal posterior compartment anatomy and its association with obstructed defecation symptoms in urogynecological patients
verfasst von: Rodrigo Guzman Rojas
Ixora Kamisan Atan
Ka Lai Shek
Hans Peter Dietz
Publikationsdatum: 15.12.2015
Verlag: Springer London
Erschienen in: International Urogynecology Journal / Ausgabe 6/2016
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-015-2914-3

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Springer Medizin

The prevalence of abnormal posterior compartment anatomy and its association with obstructed defecation symptoms in urogynecological patients

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Introduction and hypothesis

Methods

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Conclusion

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