Digestive Diseases and Sciences

, Volume 53, Issue 10, pp 2702–2709

Obstructive Defecation in Middle-aged Women

  • Madhulika G. Varma
  • Stacey L. Hart
  • Jeanette S. Brown
  • Jennifer M. Creasman
  • Stephen K. Van Den Eeden
  • David H. Thom
Original Paper

Abstract

Obstructive defecation, a significant contributor to constipation, is frequently reported in middle-aged women, yet few population-based studies have established prevalence in this group. We analyzed data from the Reproductive Risks for Incontinence Study at Kaiser, a population-based cohort of racially diverse women, 40–69 years old, to describe the prevalence of obstructive defecation and identify associated risk factors. The Reproductive Risks for Incontinence Study at Kaiser is a randomly selected cohort of 2,109 women in the Kaiser Medical System. Obstructive defecation, determined by self-report, was defined as difficulty in passing stool, hard stool, straining for more than 15 min, or incomplete evacuation, occurring at least weekly. Age, race, income, education, drinking, health status, parity, pelvic organ prolapse, urinary incontinence, number of medications, hysterectomy, surgery for pelvic organ prolapse, colectomy, irritable bowel syndrome, and body mass index were assessed for both their univariate and multivariate association with obstructive defecation. Multivariate logistic regression was used to determine the independent association between associated factors and the primary outcome of obstructive defecation. Obstructive defecation that occurred at least weekly was reported by 12.3% of women. Significant independent risk factors included irritable bowel syndrome [odds ratio 1.78, (95% confidence interval 1.21–2.60)], vaginal or laparoscopic hysterectomy [2.01 (1.15–3.54)], unemployment [2.33 (1.39–3.92)], using three or more medications [1.81 (1.36–2.42)], symptomatic pelvic organ prolapse [2.34 (1.47–3.71)], urinary incontinence surgery [2.52 (1.29–4.90)], and other pelvic surgery [1.35 (1.03–1.78)]. We concluded that obstructive defecation is common in middle-aged women, especially those with a history of treatment for pelvic floor conditions. Women who had undergone laparoscopic/vaginal hysterectomies or surgery for pelvic organ prolapse or urinary incontinence had a nearly two times greater risk of weekly obstructive defecation. Demographic factors, with the exception of employment status, were not significant, indicating that obstructive defecation, although widespread, does not affect any particular group of women.

Keywords

Constipation Obstructive defecation Epidemiology Risk factors Prevalence 

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Madhulika G. Varma
    • 1
  • Stacey L. Hart
    • 2
  • Jeanette S. Brown
    • 3
  • Jennifer M. Creasman
    • 4
  • Stephen K. Van Den Eeden
    • 5
  • David H. Thom
    • 6
  1. 1.Department of SurgeryUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Department of PsychologyRyerson UniversityTorontoCanada
  3. 3.Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of California, San FranciscoSan FranciscoUSA
  4. 4.Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoUSA
  5. 5.Kaiser Permanente Division of ResearchOaklandUSA
  6. 6.Department of Family and Community MedicineUniversity of California, San FranciscoSan FranciscoUSA

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