Abstract

Background: The relation between age, parity, and posterior pelvic floor disorders involving obstructed defecation syndrome (ODS) is a matter of controversy. This study aimed to determine the effect of pelvic floor descent (PFD) on the prevalence of posterior pelvic floor disorders in women with ODS.

Methods: Data for women with ODS, collected in a prospective pelvic floor database, and were assessed retrospectively. Data on demographic variables and defecography were analyzed. PFD during defecation was estimated by the degree of the anorectal junction in relation to the inferior margin of the ischial tuberosity.

Results: Of 334 women with ODS, the most frequently detected defecographic abnormalities were rectal intussusception (58%) and rectocele (45%). Regression analysis showed that the presence of rectocele and enterocele was more common in women with increased PFD. A higher incidence of rectocele and enterocele was found in women with excessive PFD (≧ 30 mm) than those without excessive PFD [58% (68/118) vs. 37% (77/209), P < 0.0001; 23% (27/118) vs. 14% (29/209), P = 0.038, respectively]. Increasing size of rectocele was significantly associated with increasing PFD. There were no significant differences in the prevalence of various posterior pelvic floor disorders between nulliparous and parous women.

Conclusions: The prevalence of both rectocele and enterocele increased significantly with increasing PFD in women with ODS, but the incidence of rectal intussusception showed no such relationship.

Keywords: Defecography; Pelvic Floor Descent; Rectocele; Rectal Intussusception; Enterocele

References

1. Snooks SJ., et al. “Effect of vaginal delivery on the pelvic floor: a 5-year follow-up”. British Journal of Surgery 77 (1990): 1358-1360.
2. Sultan AH., et al. “Anal-sphincter disruption during vaginal delivery”. New England Journal of Medicine 329 (1993): 1905-1911.
3. Kepenekci I., et al. “Prevalence of pelvic floor disorders in the female population and the impact of age, mode of delivery, and parity”. Diseases of the Colon and Rectum 54 (2011): 85-94.
4. Murad-Regadas S., et al. “Defecographic pelvic floor abnormalities in constipated patients: does mode of delivery matter?” Techniques in Coloproctology 13 (2009): 279-283.
5. Soares FA., et al. “Role of age, bowel function and parity on anorectocele pathogenesis according to cinedefecography and anal manometry evaluation”. Colorectal Disease 11 (2009): 947-950.
6. Karasick S., et al. “The role of parity and hysterectomy on the development of pelvic floor abnormalities revealed by defecography”. American Journal of Roentgenology 169 (1997): 1555-1558.
7. Murad-Regadas SM., et al. “The influence of age on posterior pelvic floor dysfunction in women with obstructed defecation syndrome”. Techniques in Coloproctology 16 (2012): 227-232.
8. Murad-Regadas SM., et al. “Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions”. Arquivos de Gastroenterologia 48 (2011): 265-269.
9. Parks AG., et al. “The syndrome of the descending perineum”. Proceedings of the Royal Society of Medicine 59 (1966): 477-482.
10. Bartolo DC., et al. “The relationship between perineal descent and denervation of the puborectalis in continent patients”. International Journal of Colorectal Disease 1 (1986): 91-95.
11. Tsunoda A., et al. “The effect of vaginal delivery on the pelvic floor”. Surgery Today 29 (1999): 1243-1247
12. Mellgren A., et al. “Defecography. Results of investigations in 2,816 patients”. Diseases of the Colon and Rectum 37 (1994): 1133-1141.
13. Yoshioka K., et al. “Physiologic and anatomic assessment of patients with rectocele”. Diseases of the Colon and Rectum 34 (1991): 704-708.
14. Agachan F., et al. “A constipation scoring system to simplify evaluation and management of constipated patients”. Diseases of the Colon and Rectum 39 (1996): 681-685.
15. Shorvon PJ. et al. “Defecography in normal volunteers: results and implications”. Gut 30 (1989): 1737-1749.
16. Bartram CI., et al. “Evacuation proctography: an investigation of rectal expulsion in 20 subjects without defecatory disturbance”. Gastrointestinal Radiology 13 (1988): 72-80.
17. Dietz HP. et al. “The role of childbirth in the aetiology of rectocele”. BJOG 113 (2006): 264-267.
18. Ekberg O., et al. “Defecography”. Radiology 155 (1985): 45-48
19. Vanbeckevoort D., et al. “Pelvic floor descent in females: comparative study of colpocystodefecography and dynamic fast MR imaging”. Journal of Magnetic Resonance Imaging 9 (1999): 373-37.
20. Healy JC., et al. “Dynamic MR imaging compared with evacuation proctography when evaluating anorectal configuration and pelvic floor movement”. American Journal of Roentgenology3 (1997): 775-779.
21. Francesca I., et al. “MR Imaging in Diagnosis of Pelvic Floor Descent: Supine versus Sitting Position”. Gastroenterology Research and Practice (2016): 6594152.
22. Maglinte DD., et al. “Dynamic imaging of posterior compartment pelvic floor dysfunction by evacuation proctography: techniques, indications, results and limitations”. European Journal of Radiology 61 (2007): 454-461.
23. Ahmad AN., et al. “A review of functional pelvic floor imaging modalities and their effectiveness”. Clinical Imaging 39 (2015): 559-565.
24. Segal JL., et al. “Evaluation and management of rectoceles”. Current Opinion on Urology 12 (2002): 345-352.
25. Dietz HP., et al. “Prevalence of rectocele in young nulliparous women”. Australian and New Zealand Journal of Obstetrics and Gynaecology 45 (2005): 391-394.
26. Carter D., et al. “Rectocele--does the size matter?” International Journal of Colorectal Disease 27 (2012): 975-980.
27. Hawkins AT., et al. “Impact of Rising Grades of Internal Rectal Intussusception on Fecal Continence and Symptoms of Constipation”. Diseases of the Colon and Rectum 59 (2016): 54-61.
28. Mellgren A., et al. “Enterocele demonstrated by defaecography is associated with other pelvic floor disorders”. International Journal of Colorectal Disease 9 (1994): 121-124.
29. Cruikshank SH. “Preventing vault prolapse and enterocele after vaginal hysterectomy”. South Medical Journal 81 (1988): 594-596.
30. Chou Q., et al. “Clinical presentation of enterocele”. Obstetrics and Gynecology 96 (2000): 599-603.

Citation

Citation: Akira Tsunoda., et al. “Effect of Pelvic Floor Descent on Posterior Pelvic Floor Disorders in Women with Obstructed Defecation Syndrome". Acta Scientific Women's Health 2.10 (2020): 36-42.

Copyright

Copyright: © 2020 Akira Tsunoda., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.