Transactions from the Thirty-Second Annual Scientific Meeting of the Society of Gynecologic SurgeonsPosterior vaginal wall prolapse does not correlate with fecal symptoms or objective measures of anorectal function
Section snippets
Methods
This is an institutional review board–approved prospective observational cohort study of all patients with fecal dysfunction and prolapse or urinary symptoms who were evaluated at a multidisciplinary pelvic floor center (July 2003 to January 2005). Patients were first seen by a urogynecologist and were referred for colorectal evaluation in the presence of bowel symptoms that were detected on medical history intake. The exclusion criteria included women who were <18 years old, pregnancy, history
Comment
Despite the frequent coexistence of pelvic organ prolapse and bowel symptoms, a relationship between them has not been demonstrated. The main aim of our study was to investigate such a correlation in patients with pelvic floor dysfunction and to use anorectal physiologic studies to aid in the evaluation of bowel symptoms. We grouped patients as stages 0 to I or stages II through IV, which assumes the hymen is an important “cut off point” for symptom development.13 As reported in previous
Acknowledgments
We thank Joseph Feldman, DrPH, Professor of Preventive Medicine and Community Health, State University of New York (SUNY Downstate), Brooklyn, NY, Elina Yakirevich, RPA, Center for Pelvic Floor Dysfunction and Reconstructive Surgery, Department of Surgery, Maimonides Medical Center, Brooklyn, NY.
References (17)
- et al.
Posterior vaginal wall prolapse and bowel function
Am J Obstet Gynecol
(1998) - et al.
Correlation of symptoms with location and severity of pelvic organ prolapse
Am J Obstet Gynecol
(2001) - et al.
The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction
Am J Obstet Gynecol
(1996) - et al.
Clinical applications and techniques of cinedefecography
Am J Surg
(2001) The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care
Am J Obstet Gynecol
(2000)- et al.
Pelvic organ support study and bowel symptoms: straining at stool is associated with perineal and anterior vaginal descent in a general gynecologic population
Am J Obstet Gynecol
(2005) - et al.
A practical guide to basic anorectal physiology investigations
Contemp Surg
(1993) - et al.
How useful are manometric tests of anorectal functions in the management of defecation disorders?
Am J Gastroenterol
(1997)
Cited by (40)
The relationship of defecation symptoms and posterior vaginal wall prolapse in women undergoing pelvic organ prolapse surgery
2019, American Journal of Obstetrics and GynecologyCitation Excerpt :Saks et al13 and Fialkow et al14 found an association between the presence but not the severity of posterior vaginal wall prolapse and obstructed defecation symptoms. However, many studies have failed to find any relationship.4–12 Often the authors have concluded that the lack of this relationship suggests posterior wall prolapse not being a causal factor behind obstructed defecation symptoms.3,6,10,13
Defecatory dysfunction and fecal incontinence in women with or without posterior vaginal wall prolapse as measured by pelvic organ prolapse quantification (POP-Q)
2017, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :Defecatory dysfunction (difficulty in defecation with excessive straining to empty the bowels, feeling of incomplete bowel emptying, constipation, and manual evacuation with digital assistance) is often present in patients with POP [3–5]. However, it is unclear whether the abnormal anatomical positions of the bladder, bowel, and uterus compromise bladder and bowel function directly, or whether abnormal anatomy and dysfunction of the pelvic floor share a common etiology [6–13]. Gynecologists do not always inquire about bowel dysfunction [14], and Dua et al. [10] reported that colorectal symptoms may be ignored in women presenting to gynecology clinics with prolapse.
Fecal Incontinence and Pelvic Floor Dysfunction in Women: A Review
2016, Gastroenterology Clinics of North AmericaCitation Excerpt :However, multiple studies have shown that the degree of bowel symptoms does not correlate with severity of prolapse (and therefore response to surgical intervention).112–114 Furthermore, when physiologic tests (ARM, pudendal nerve latency testing, surface EMG, transanal ultrasonography, or defecography) were added to the work-up, there was still no correlation between degree of bowel symptoms and severity of posterior vaginal wall prolapse.116 Patients with rectoceles should be counseled on the use of vaginal splinting during bowel movements.
Consistently inconsistent, the posterior vaginal wall
2016, American Journal of Obstetrics and GynecologyCitation Excerpt :The limitation of our physical examination in predicting symptoms is clear and not reassuring. Adding physiological testing (anal manometry, pudendal terminal motor latencies, electromyography) to physical examination and imaging in patients, the authors concluded that there is no correlation between posterior vaginal wall prolapse with bowel symptoms or objective measures of anorectal function.5 The authors studying ODS symptoms and their relationship to rectocele concluded that rectoceles were not associated with increased severity of ODS symptoms, anorectal abnormalities, or pelvic floor dyssynergia.
Diagnosis and treatment of faecal incontinence: Consensus statement of the Italian Society of Colorectal Surgery and the Italian Association of Hospital Gastroenterologists
2015, Digestive and Liver DiseaseCitation Excerpt :The success rate is good in the short term but declines with time and the complication rate is very high (3a-B). FI is reported to be associated with pelvic organ prolapse in 50–75% of patients with rectal prolapse [113], 32–40% with rectal intussusception [112,348–350] and 20–54% with genital prolapses [351–357]. Up to 13–30% of patients with a rectocele and prolapse have FI, usually to a greater extent [351,358,359].
Clinical examination of prolapse
2009, Progres en Urologie
Presented at the Thirty-Second Annual Meeting of the Society of Gynecologic Surgeons, April 3-5, 2006, Tucson, AZ.