The 'bother' of obstructed defecation

Area of Science:

• Urogynecology
• Pelvic Floor Disorders
• Gastroenterology

Background:

• Obstructed defecation (OD) significantly impacts quality of life.
• Understanding factors influencing OD bother is crucial for effective management.
• Previous studies have explored clinical correlates, but sonographic associations require further investigation.

Purpose of the Study:

• To investigate the relationship between visual analog scale (VAS) 'bother' scores for OD and demographic, physical examination, and sonographic findings of the posterior pelvic compartment.

Main Methods:

• A prospective study included 265 patients at a urogynecology clinic.
• OD diagnosis was based on symptoms like incomplete emptying, straining, or need for digitation.
• Patients rated OD bother using a 0-10 VAS. Pelvic organ prolapse quantification and 4D translabial ultrasound were performed.

Main Results:

• 61% of patients had OD, with a mean VAS bother score of 5.6.
• OD bother correlated with prior prolapse surgery, hysterectomy, posterior compartment descent (Bp), and hiatal dimensions (Pb, Gh+Pb).
• Sonographic findings associated with OD bother included rectocele, rectal ampulla descent, enterocele, and rectal intussusception.

Conclusions:

• VAS bother scores for OD are linked to clinical and sonographic indicators of posterior compartment descent.
• Rectal intussusception emerged as the strongest sonographic predictor of highly bothersome OD symptoms.