Structural, functional, and symptomatic differences between women with rectocele versus cystocele and normal support

Area of Science:

• Urogynecology and Pelvic Reconstructive Surgery
• Female Pelvic Medicine and Reconstructive Surgery
• Anatomy and Physiology of the Pelvic Floor

Background:

• Vaginal prolapse, affecting anterior and posterior walls, is often linked to apical descent and levator ani muscle defects.
• The precise contribution of these factors to different vaginal compartments and their unique symptoms remains unclear.

Purpose of the Study:

• To compare the association between apical support, levator ani muscles, and pelvic floor symptoms in women with posterior-predominant prolapse, anterior-predominant prolapse, and normal support.

Main Methods:

• Cross-sectional study with 60 posterior prolapse, 90 anterior prolapse, and 103 control subjects.
• Pelvic organ prolapse quantification, MRI for levator muscle defects, and Pelvic Floor Distress Inventory-Short Form were used.

Main Results:

• Anterior prolapse showed significantly greater apical descent and a higher incidence of normal levator muscles compared to posterior prolapse.
• Both prolapse groups had more severe pelvic floor symptoms and weaker vaginal closure forces than controls, with no significant difference between prolapse groups after adjusting for size.

Conclusions:

• Posterior prolapse involves less apical descent and has a lower impact from levator ani defects compared to anterior prolapse.
• Pelvic floor symptoms are more indicative of prolapse presence and size than the specific vaginal compartment involved.