Is posterior compartment prolapse associated with anal incontinence?

Area of Science:

• Urogynecology
• Pelvic Floor Disorders
• Diagnostic Imaging

Background:

• Posterior compartment prolapse manifestations like rectocele, enterocele, and intussusception are anecdotally linked to anal incontinence (AI).
• Previous studies have not adequately controlled for anal sphincter trauma when examining this association.
• Pelvic floor dysfunction is a common condition affecting women, often involving multiple compartments.

Purpose of the Study:

• To investigate the association between posterior compartment prolapse and anal incontinence (AI) in women with intact anal sphincters.
• To differentiate the impact of various posterior compartment prolapse types on AI.
• To conduct the study while controlling for the presence or absence of anal sphincter trauma.

Main Methods:

• Retrospective analysis of 1133 women with intact anal sphincters presenting with pelvic floor dysfunction.
• Standardized interviews assessing AI symptoms, clinical examination, and 3D/4D transperineal ultrasound.
• Offline diagnosis of rectal ampulla descent, true rectocele, enterocele, intussusception, and anal sphincter trauma.

Main Results:

• Overall, 61% had clinical posterior compartment prolapse and 56% had imaging-diagnosed prolapse (rectocele 47%, enterocele 7.9%, intussusception 2.3%).
• Women with ultrasound-diagnosed enterocele showed a higher rate of AI (23.6% vs 12.3%).
• However, this association between enterocele and AI was not significant after adjusting for confounders (OR, 1.56; P=0.134).

Conclusions:

• Posterior compartment prolapse, diagnosed clinically or by imaging, is not associated with anal incontinence in women without anal sphincter trauma.
• The findings suggest that anal sphincter integrity is a crucial factor when evaluating AI in women with pelvic floor dysfunction.
• Further research may be warranted to explore other contributing factors to AI in this population.