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

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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.

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Authors and Affiliations

  1. Department of Obstetrics, Gynecology and Neonatology, Sydney Medical School Nepean, University of Sydney, Penrith, Australia

    Rodrigo Guzman Rojas, Ixora Kamisan Atan, Ka Lai Shek & Hans Peter Dietz

  2. Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Avenida Vitacura 5951, Vitacura, Santiago, Chile, 7650568

    Rodrigo Guzman Rojas

  3. Departamento de Ginecología y Obstetricia, Hospital Clínico de la Universidad de Chile, Santiago, Chile

    Rodrigo Guzman Rojas

  4. Department of Obstetrics and Gynecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia

    Ixora Kamisan Atan

  5. Department of Obstetrics and Gynecology, Liverpool Clinical School, University of Western Sydney, Parramatta, Australia

    Ka Lai Shek

Authors
  1. Rodrigo Guzman Rojas
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  2. Ixora Kamisan Atan
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  3. Ka Lai Shek
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  4. Hans Peter Dietz
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Corresponding author

Correspondence to Rodrigo Guzman Rojas.

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Conflicts of interest

H.P. Dietz and K.L. Shek have received unrestricted educational grants from GE; R.A. Guzmán Rojas and I. Kamisan Atan report that they have no conflicts of interest.

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Guzman Rojas, R., Kamisan Atan, I., Shek, K.L. et al. The prevalence of abnormal posterior compartment anatomy and its association with obstructed defecation symptoms in urogynecological patients. Int Urogynecol J 27, 939–944 (2016). https://doi.org/10.1007/s00192-015-2914-3

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  • DOI: https://doi.org/10.1007/s00192-015-2914-3

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