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Anogenital Distance and Perineal Measurements of the Pelvic Organ Prolapse POP Quantification System

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Characteristics and evolution of pelvic floor structures in female patients aged over 40 years with constipation-a

Jiarong You^1,2, Ying Chen^3,4, Rongpu Liang^1,2,3

¹Department of Gastrointestinal Surgery, Lingnan Hospital, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China.

|February 18, 2026

Abstract

Background:

Pelvic floor dysfunction (PFD) is a common cause of chronic constipation which can reciprocally exacerbate pelvic floor burden. However, the characteristics and evolution of pelvic floor structures in patients with constipation remain unclear. This study investigates the characteristics and evolution of pelvic floor structures in constipated women aged over 40 years.

Methods:

Clinical data were collected from female patients undergoing pelvic floor ultrasound at the Third Affiliated Hospital of Sun Yat-sen University from December 2020 to August 2023. Propensity score matching (PSM) minimized confounders between the constipation (n = 247) and non-constipation (n = 898) groups. We analyzed intergroup differences in ultrasound data and changes in pelvic floor structure over time among constipated patients.

Results:

Significant intergroup differences emerged in uterine prolapse (P = 0.042), rectocele (P = 0.022), levator ani hiatus dilation (P=0.013), hiatus area (P < 0.01), the position of the uterus (P < 0.01), and rectal ampulla (P = 0.017) at maximal Valsalva maneuver (VM). Multivariate analysis identified rectocele (P = 0.023) and uterine descent at maximal VM (P = 0.026) as positively associated with constipation occurrence. Multiple ultrasonographic evaluations over two years revealed stable pelvic floor anatomy in non-constipated individuals but identified alterations in 78 constipated patients, including increased vesicocele (P = 0.039), uterine prolapse (P = 0.019), perineal hypermobility (P = 0.015), lower bladder (P < 0.001) and rectal ampulla (P < 0.01) positions at maximal VM, greater bladder descent (P < 0.01), and enlarged hiatus area (P < 0.01).

Conclusion:

This study demonstrates that rectocele and uterine descent at maximal VM exhibit positive associations with constipation. Over time, further descent of the bladder, uterus, and rectum occurs in female patients with constipation, along with an increase in perineal mobility and levator ani hiatus area.

Keywords:

Constipation Pelvic floor structure Pelvic floor ultrasound Propensity score matching analysis Retrospective study

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