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Posterior pelvic tilt is a risk factor for rectal prolapse: a propensity score matching analysis

Techniques in Coloproctology volume 24, pages 463–469 (2020)Cite this article

Abstract

Background

There is little evidence about possible effects of pelvic anatomical characteristics on proctological complications. The aim of our study was to investigate the potential correlation between sagittal pelvic position and rectal prolapse.

Methods

A study was conducted on a proctology patients and patients without any specific history of proctological disorders who were divided into two groups according to the presence or the absence of rectal prolapse. In all cases, the pelvic angle was measured with a pelvic goniometer and categorized as posterior (< 10°), neutral (10°–15°), and anterior (> 15°). To minimize effects of potential confounders in the analysis, 3:1 nearest neighbor propensity score matching (PSM) method was implemented using age, sex, and diagnose of rectal disorders as confounding variables.

Results

Among the 143 screened patients, posterior tilt was more frequent in the 19 patients with rectal prolapse than in those without prolapse (42 vs. 18%; p = 0.027). This result was also confirmed in the post-PSM analysis (42 vs. 14%; p = 0.036) using 35 propensity score (PS)-matched controls compared with the rectal prolapse group. Posterior tilt was associated with an increased risk of prolapse in both the unmatched population (odds ratio = 3.37; p = 0.020) and PS-matched subset (odds ratio = 4.36; p = 0.028).

Conclusions

A posterior pelvic angle was more frequently associated with the diagnosis of rectal prolapse. In both the entire population and in the PS-matched subset, posterior tilt was a significant risk factor for rectal prolapse. The easy-to-do investigation of the pelvic angle can provide several benefits in terms of rectal prolapse prevention and more precise management of post-surgical prolapse recurrence.

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References

  1. Bordeianou L, Rockwood T, Baxter N, Lowry A, Mellgren A, Parker S (2008) Does incontinence severity correlate with quality of life? Prospective analysis of 502 consecutive patients. Colorectal Dis 10(3):273–279

    Article  CAS  Google Scholar 

  2. Schaffer JI, Wai CY, Boreham MK (2005) Etiology of pelvic organ prolapse. Clin Obstet Gynecol 48(3):639–647

    Article  Google Scholar 

  3. Shultz SJ, Nguyen AD, Windley TC, Kulas AS, Botic TL, Beynnon BD (2006) Intratester and intertester reliability of clinical measures of lower extremity anatomic characteristics: implications for multicenter studies. Clin J Sport Med 16(2):155–161

    Article  Google Scholar 

  4. Fortin C. Développement et validation d’un outil clinique pour l’analyse quantitative de la posture auprès de personnes atteintes d’une scoliose idiopathique. https://hdl.handle.net/1866/4182. Accessed 15 Jan 2019

  5. Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976) 30(3):346–353

    Article  Google Scholar 

  6. Wijffels NA, Collinson R, Cunningham C, Lindsey I (2010) What is the natural history of internal rectal prolapse? Colorectal Dis 12:822–830

    Article  CAS  Google Scholar 

  7. Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A, Goldman HB, Huser M, Milani AL, Moran PA, Schaer GN, Withagen MIJ (2016) Erratum to: An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J 27:655–684

    Article  Google Scholar 

  8. Parekh M, Swift S, Lemos N, Iskander M, Freeman B, Arunkalaivanan AS, Martan A, Sorinola O, Rizk D, Halaska M, Surkont G, Medina C, Conceicao JC, Korte JE (2011) Multicentre inter-examiner trial of the validation of simplified POPQ system. Int Urogynecol J 22:645–650

    Article  Google Scholar 

  9. Altomare DF, Spazzafumo L, Rinaldi M, Dodi G, Ghiselli R, Piloni V (2008) (2008), Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome. Colorectal Dis 10:84–88

    CAS  PubMed  Google Scholar 

  10. Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36(1):77–97

    Article  CAS  Google Scholar 

  11. Sprigle S, Flinn N, Wootten M, McCorry S (2003) Development and testing of a pelvic goniometer designed to measure pelvic tilt and hip flexion. Clin Biomech (Bristol, Avon) 18(5):462–465

    Article  Google Scholar 

  12. Hwang YI, Kim KS (2018) Effects of pelvic tilt angles and forced vital capacity in healthy individuals. J Phys Ther Sci 30(1):82–85

    Article  Google Scholar 

  13. Lim HS, Roh SY, Lee SM (2013) The relationship between pelvic tilt angle and disability associated with low back pain. J Phys Ther Sci 25:65–68

    Article  Google Scholar 

  14. Capson AC, Nashed J, Mclean L (2011) The role of lumbopelvic posture in pelvic floor muscle activation in continent women. J Electromyogr Kinesiol 21(1):166–177

    Article  Google Scholar 

  15. Delancey J (1994) Structural support of the urethra as it relates to stress incontinence: the Harmmock hypothesis. Am J Obstet Gynecol 170:1713–1723

    Article  CAS  Google Scholar 

  16. Minaire P, Lyonnet A, Sabot E, Chevallard JB, Capdepon C (1998) Rééducation Périneale et statique lombo-pelvienne. Ann Kinesither 15:391–394

    Google Scholar 

  17. Kamina P, Chansigaud JP (1988) Support and suspension of the pelvic viscera in women. Functional and surgical anatomy. J Gynecol Obstet Biol Reprod (Paris) 17(7):835–848

    CAS  Google Scholar 

  18. Fozzatti C, Herrmann V, Palma T, Riccetto CL, Palma PC (2010) Global postural re-education: an alternative approach for stress urinary incontinence? Eur J Obstet Gynecol Reprod Biol 152(2):218–224

    Article  Google Scholar 

  19. Adusumilli S, Gosselink MP, Fourie S et al (2013) Does the presence of a high grade internal rectal prolapse affect the outcome of pelvic floor retraining in patients with faecal incontinence or obstructed defaecation? Colorectal Dis 15(11):e680–e685

    Article  CAS  Google Scholar 

  20. Ram E, Hoffman A, Goldes Y et al (2018) Perineal stapled rectal prolapse resection in elderly patients: long-term follow-up. Dis Colon Rectum 61(11):1316–1319

    Article  Google Scholar 

  21. Gleditsch D, Wexels WA, Nesbakken A (2018) Surgical options and trends in treating rectal prolapse: long-term results in a 19-year follow-up study. Langenbecks Arch Surg 403(8):991–998

    Article  Google Scholar 

  22. Ris F, Gorissen KJ, Ragg J, Gosselink MP, Buchs NC, Hompes R, Cunningham C, Jones O, Slater A, Lindsey I (2017) Rectal axis and enterocele on proctogram may predict laparoscopic ventral mesh rectopexy outcomes for rectal intussusception. Tech Coloproctol 21(8):627–632

    Article  CAS  Google Scholar 

  23. Hasebe K, Okubo Y, Kaneoka K, Takada K, Suzuki D, Sairyo K (2016) The effect of dynamic stretching on hamstrings flexibility with respect to the spino-pelvic rhythm. J Med Invest 63(1–2):85–90

    Article  Google Scholar 

  24. Moon SH, Boo JA, Park SE (2016) Effects of ankle plantar flexors stretching with closed kinetic chain on pelvic movements and gait speed in hemiplegia patients: a case study. J Phys Ther Sci 28(1):309–313

    Article  Google Scholar 

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Acknowledgements

The authors thank Alessio Gargaro for the statistical analysis and his contributions during text revision.

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Authors and Affiliations

  1. Health Local Unit ASL Rome 3, Via Portuense, 292, Rome, Italy

    C. Cantiani

  2. Italian Association for Postural Global Reeducation, AIRPG, Ivrea, Italy

    D. Sgamma & O. R. Meli

  3. Rome Physical Therapy Division, FisioClinic Italia, Rome, Italy

    E. Grossi & D. Saccá

  4. General Surgery and Organ Transplantation Department, Sapienza University of Rome, Rome, Italy

    Q. Lai & F. Gaj

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  1. C. Cantiani
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  2. D. Sgamma
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  3. E. Grossi
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  4. D. Saccá
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  5. O. R. Meli
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Correspondence to C. Cantiani.

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The authors have no conflicts of interest to disclose the content of the paper. The study did not receive any third-party financial support.

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All procedures performed in this study were in accordance with ethical standard, with 1964 Helsinki declaration and its later amendments, and were approved by the competent Ethics Committee.

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Written informed consent was obtained from all participants.

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Cantiani, C., Sgamma, D., Grossi, E. et al. Posterior pelvic tilt is a risk factor for rectal prolapse: a propensity score matching analysis. Tech Coloproctol 24, 463–469 (2020). https://doi.org/10.1007/s10151-020-02179-9

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  • DOI: https://doi.org/10.1007/s10151-020-02179-9

Keywords

  • Prolapse
  • Pelvic tilt
  • Proctology
  • Complication