Pelvic organ prolapse in defecatory disorders

Area of Science:

• Urogynecology
• Gastroenterology
• Pelvic Floor Disorders

Background:

• Pelvic organ prolapse (POP) and defecatory disorders are common conditions affecting women.
• The relationship between POP and specific defecatory disorders like fecal incontinence and obstructed defecation requires further clarification.

Purpose of the Study:

• To compare the prevalence of pelvic organ prolapse (POP) in women with defecatory disorders (fecal incontinence, obstructed defecation) versus healthy controls.

Main Methods:

• A urogynecologist assessed POP using the Pelvic Organ Prolapse Quantification (POPQ) system.
• A gastroenterologist evaluated perineal descent during simulated evacuation.
• Multiple logistic regression analyzed obstetric-gynecological variables and their association with defecatory disorders.

Main Results:

• Stage II or greater POP was found in 55% of controls, 42% with obstructed defecation, and 29% with fecal incontinence.
• Fecal incontinence was associated with a lower risk of stage II or greater POP (OR=0.1), even after controlling for obstetric risk factors and hysterectomy.
• Excessive perineal descent, associated with POP, was more prevalent in those with obstructed defecation (18%) compared to controls (7%) and fecal incontinence (7%).

Conclusions:

• Pelvic organ prolapse severity was lower in women with fecal incontinence than in controls, despite higher risk factors for pelvic floor injury.
• A subset of women with defecatory disorders, particularly obstructed defecation, exhibit excessive perineal descent, which is linked to pelvic organ prolapse.