Correlation of Obstructed Defecation Syndrome with Pelvic Organ Prolapse and Anorectal Manometry

Ghanbari, Zinat; Pourali, Leila; Eftekhar, Tahereh; Deldar Pesikhani, Maryam; Darvish, Soudabeh; Lotfi, Zahra; Ayati, Elnaz

doi:10.30699/jogcr.9.2.144

Document Type : Original Research Article

Authors

¹ Department of Obstetrics and Gynecology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

² Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

³ Department of Obstetrics and Gynecology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

⁴ Department of Midwifery, Tehran University of Medical Sciences, Tehran, Iran

https://doi.org/10.30699/jogcr.9.2.144

Abstract

Background & Objective: Defecatory dysfunction is a common problem among women who are referred for urogynecological care. Pelvic organs prolapse (POP) which is a downward displacement of pelvic organs is one of the common conditions among patients with defecatory problems. This study was planned to evaluate the correlation of obstructive defecatory symptoms with the site and severity of pelvic organ prolapse and the anorectal manometry results.
Materials & Methods: This cross-sectional study was performed between Dec 2018 and Nov 2019. A total of 150 women with symptoms of defecatory problems were enrolled. Patients were classified in two groups according to each compartment prolapse staging and severity: stage ≤2 and stage >2. The correlation between defecatory symptoms and pelvic organ prolapse examination, anorectal examination and anal manometry were evaluated.
Results: A total of 150 women were evaluated. There was a significant correlation between higher stage of anterior compartment prolapse (cystocele stage>2) and constipation (P=0.035). Although all the defecatory symptoms were more frequent in anterior prolapse stage>2, but the difference was not significant (P>0.05). There was no significant correlation between defecatory symptoms and severity of posterior compartment prolapse. There was a significant correlation between stage>2 of apical prolapse and all the defecatory symptoms (P≤0.05). The abnormal anal resting and squeeze pressure and abnormal balloon expulsion test were more frequent in stage >2 of all compartments prolapse, but the difference was not significant (P>0.05).
Conclusion: Obstructed defecation syndrome was more frequent in patients with higher stages of anterior and apical prolapse. Abnormal manometry results were more frequent in patients with defecatory dysfunction with advanced vaginal prolapse.

Keywords

Main Subjects

General Gynecology and Pelvic Floor

References

1. Brown H, Grimes C. Current Trends in Management of Defecatory Dysfunction, Posterior Compartment Prolapse, and Fecal Incontinence. Curr Obstet Gynecol Rep. 2016;5(2):165-71. [DOI:10.1007/s13669-016-0148-0] [PMID] [PMCID]

2. Raza-Khan F, Cunkelman J, Lowenstein L, Shott S, Kenton K. Prevalence of bowel symptoms in women with pelvic floor disorders. Int Urogynecology J. 2010;21(8):933-8. [DOI:10.1007/s00192-010-1143-z] [PMID]

3. Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A, et al. An International Urogynecological Association (IUGA) / International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Organ Prolapse (POP). Neurourol Urodyn. 2016;35(2):137-68. [DOI:10.1002/nau.22922] [PMID]

4. Grimes CL, Schimpf MO, Wieslander CK, Sleemi A, Doyle P, Wu Y, et al. Surgical interventions for posterior compartment prolapse and obstructed defecation symptoms: a systematic review with clinical practice recommendations. Int Urogynecology J. 2019;30(9):1433-54. [DOI:10.1007/s00192-019-04001-z] [PMID]

5. Rezaie A, Gu P, Kaplan GG, Pimentel M, Al-Darmaki AK. Dyssynergic Defecation in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Inflamm Bowel Dis. 2018;24(5):1065-73. [DOI:10.1093/ibd/izx095] [PMID]

6. Karjalainen PK, Mattsson NK, Nieminen K, Tolppanen A-M, Jalkanen JT. The relationship of defecation symptoms and posterior vaginal wall prolapse in women undergoing pelvic organ prolapse surgery. Am J Obstet Gynecol. 2019;221(5):480.e1-.e10. [DOI:10.1016/j.ajog.2019.05.027] [PMID]

7. Guzman Rojas R, Kamisan Atan I, Shek KL, Dietz HP. The prevalence of abnormal posterior compartment anatomy and its association with obstructed defecation symptoms in urogynecological patients. Int Urogynecology J. 2016;27(6):939-44. [DOI:10.1007/s00192-015-2914-3] [PMID]

8. Ghanbari Z, Pourali L, Deldar Pesikhani M, Darvish S, Ayati E, Mehrad Majd H, et al. The relationship between clinical symptoms with pop-Q stage. Iran J Obstet Gynecol Infertil. 2022;25(7):1-7.

9. Vasconcelos Neto JA, Vasconcelos CTM, Regadas SMM, Bezerra LRPS, Lustosa KA, Karbage SAL. Clinical impact of bowel symptoms in women with pelvic floor disorders. Int Urogynecology J. 2017;28(9):1415-20. [DOI:10.1007/s00192-017-3288-5] [PMID]

10. Dietz HP. Rectocele or stool quality: what matters more for symptoms of obstructed defecation? Tech Coloproctol. 2009;13(4):265-8. [DOI:10.1007/s10151-009-0527-x] [PMID]

11. Grimes CL, Tan-Kim J, Nager CW, Dyer KY, Menefee SA, Diwadkar GB, et al. Outcome measures to assess anatomy and function of the posterior vaginal compartment. Int Urogynecology J. 2014;25(7):893-9. [DOI:10.1007/s00192-013-2303-8] [PMID]

12. Arian A, Ghanbari Z, Miratashi Yazdi SN, Deldar Pesikhani M, Yousefi M. The High Rate of Discordance Between Clinical Symptoms and MRI Findings in Patients with Pelvic Floor Dysfunction. J Obstet Gynecol Cancer Res. 2022;7(4):296-303. [DOI:10.30699/jogcr.7.4.296]

13. Saks EK, Harvie HS, Asfaw TS, Arya LA. Clinical significance of obstructive defecatory symptoms in women with pelvic organ prolapse. Int J Gynaecol Obstet. 2010;111(3):237-40. [DOI:10.1016/j.ijgo.2010.06.025] [PMID]

14. Riss S, Stift A. Surgery for obstructed defecation syndrome - is there an ideal technique. World J Gastroenterol. 2015;21(1):1-5. [DOI:10.3748/wjg.v21.i1.1] [PMID] [PMCID]

15. Rostaminia G, Abramowitch S, Chang C, Goldberg RP. Descent and hypermobility of the rectum in women with obstructed defecation symptoms. Int Urogynecology J. 2020;31(2):337-49. [DOI:10.1007/s00192-019-03934-9] [PMID]

16. Andy UU, Harvie HS, Pahwa AP, Markland A, Arya LA. The relationship between fecal incontinence, constipation and defecatory symptoms in women with pelvic floor disorders. Neurourol Urodyn. 2017;36(2):495-8. [DOI:10.1002/nau.22964] [PMID]

17. Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R. Bowel Disorders. Gastroenterology. 2016;S0016-5085(16):00222-5.

18. Berek JS. Berek & Novak's gynecology: Lippincott Williams & Wilkins; 2019.

19. Erekson EA, Kassis NC, Washington BB, Myers DL. The Association Between Stage II or Greater Posterior Prolapse and Bothersome Obstructive Bowel Symptoms. Female Pelvic Med Reconstr Surg. 2010;16(1):59-64. [DOI:10.1097/SPV.0b013e3181ce958a] [PMID]

20. Shima T, Amamoto R, Kaga C, Kado Y, Sasai T, Watanabe O, et al. Association of life habits and fermented milk intake with stool frequency, defecatory symptoms and intestinal microbiota in healthy Japanese adults. Benef Microbes. 2019;10(8):841-54. [DOI:10.3920/BM2019.0057] [PMID]

21. Ito D, Yamamoto Y, Maekita T, Yamagishi N, Kawashima S, Yoshikawa T, et al. Do synbiotics really enhance beneficial synbiotics effect on defecation symptoms in healthy adults?: Randomized, double-blind, placebo-controlled trial. Medicine. 2022;101(8):e28858. [DOI:10.1097/MD.0000000000028858] [PMID] [PMCID]

22. Chou AB, Cohan JN, Varma MG. Differences in symptom severity and quality of life in patients with obstructive defecation and colonic inertia. Dis Colon Rectum. 2015;58(10):994-8. [DOI:10.1097/DCR.0000000000000439] [PMID]

23. Chaudhry Z, Tarnay C. Descending perineum syndrome: a review of the presentation, diagnosis, and management. Int Urogynecology J. 2016;27:1149-56. [DOI:10.1007/s00192-015-2889-0] [PMID]

24. da Silva GM, Gurland B, Sleemi A, Levy G. Posterior vaginal wall prolapse does not correlate with fecal symptoms or objective measures of anorectal function. Am J Obstet Gynecol. 2006;195(6):1742-7. [DOI:10.1016/j.ajog.2006.07.034] [PMID]

25. Rao SS, Patcharatrakul T. Diagnosis and Treatment of Dyssynergic Defecation. J Neurogastroenterol Motil. 2016;22(3):423-35. [DOI:10.5056/jnm16060] [PMID] [PMCID]

26. Ugo G, Emma VC, Adil EB, Emma JH, Scott SM, Charles HK. Diagnostic accuracy study of anorectal manometry for diagnosis of dyssynergic defecation. Gut. 2016;65(3):447-57. [DOI:10.1136/gutjnl-2014-308835] [PMID] [PMCID]

Journal of Obstetrics, Gynecology and Cancer Research

Correlation of Obstructed Defecation Syndrome with Pelvic Organ Prolapse and Anorectal Manometry

References

References

Volume 9, Issue 2 - Serial Number 37
March and April 2024
Pages 144-149

Correlation of Obstructed Defecation Syndrome with Pelvic Organ Prolapse and Anorectal Manometry

References

References

Volume 9, Issue 2 - Serial Number 37March and April 2024Pages 144-149

Volume 9, Issue 2 - Serial Number 37
March and April 2024
Pages 144-149