Document Detail


Posterior vaginal wall prolapse does not correlate with fecal symptoms or objective measures of anorectal function.
MedLine Citation:
PMID:  17132476     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The purpose of this study was to evaluate the relationship among the degree of posterior vaginal wall prolapse, anorectal symptoms, and physiology. STUDY DESIGN: This was a prospective study that included patients with fecal dysfunction and prolapse/urinary symptoms. A validated instrument for fecal incontinence and the ROME II criteria were used. Anal physiologic testing was performed selectively on the basis of bowel symptoms. Patients were divided into 2 groups by pelvic organ prolapse quantification score clinical examination: group I: Ap/Bp < -1, and group II: Ap/Bp > or = -1. The association among the degree of prolapse, bowel symptoms, and physiologic findings was examined with the use of Fisher's exact test and logistic regression models. RESULTS: One hundred thirty-two patients with a mean age of 63 years (range, 24-90 years) were evaluated. There were 62 patients (47%) in group I and 70 patients (53%) in group II. Overall, 40.9% of the patients had constipation/obstructed defecation, and 25% of the patients had fecal incontinence. Ninety-seven patients underwent physiologic testing. At manometry, both resting and squeeze pressures were significantly higher in patients in group II. Overall, patients with a higher resting pressure (P = .001) and increased rectal capacity (P = .008) were more likely to be continent, and patients with a lower squeeze pressure were more likely to be incontinent (P = .001). Ultrasonography demonstrated anterior sphincter defect in 21.9% of the patients and a perineal body of <10 mm in 35.6% of the patients, with no correlation with the degree of prolapse. Patients with sphincter defects were 3 times more likely to have fecal incontinence (95% CI, 1.03, 8.75; P = .04). There was no association between electromyography and pudendal nerve terminal latencies and the degree of prolapse. Patients with prolonged pudendal nerve terminal latencies were more likely to be incontinent (P = .033). On defecography, 28% of the patients had concomitant enterocele, and 21.3% of the patients had intussusception, which was not detected by physical examination. CONCLUSION: Anorectal symptoms do not correlate with the degree of posterior vaginal wall prolapse, nor does the presence of prolapse equate to abnormal physiologic test results. Bowel symptoms may result from primary anorectal abnormalities, which are demonstrated by physiologic studies.
Authors:
Giovanna Marques da Silva; Brooke Gurland; Ambereen Sleemi; Gil Levy
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  195     ISSN:  1097-6868     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2006-11-29     Completed Date:  2006-12-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1742-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Center for Pelvic Floor Dysfunction and Reconstructive Surgery, Maimonides Medical Center, Brooklyn, NY, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Anal Canal / physiopathology*
Constipation / etiology*
Electromyography
Fecal Incontinence / etiology*
Female
Humans
Manometry
Middle Aged
Prospective Studies
Rectum / physiopathology*
Uterine Prolapse / complications*,  physiopathology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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