Defecation Posture Modification Device Effect on Postoperative Bowel Function: An RCT

Defecatory symptoms are a concern for patients after pelvic reconstructive surgery. Devices that change the anorectal angle improve bowel function; however, this has not been assessed in the pelvic reconstructive surgery population.

The objective of this study was to evaluate if a defecation posture modification device improves straining with the first bowel movement after posterior colporrhaphy.

We conducted a nonblinded, randomized controlled trial of individuals undergoing posterior colporrhaphy. Participants were randomized to receive either a defecation posture modification device or no device. All participants were discharged with our standard pain and bowel regimen. The primary outcome was straining with the first bowel movement on a 10-point visual analog scale (VAS). Secondary outcomes included pain, satisfaction, Bristol Stool Form Scale classification, medication use, and device satisfaction.

Among 160 women enrolled, 150 were analyzed. Demographics were similar between groups, with most patients in their 60s, Caucasian, and with stage 2 prolapse. For the primary outcome, there was no difference in strain with the first bowel movement between arms, with the median level of strain noted as 2 out of 10. There was no difference in the level of pain. Most documented stools are a 4 or higher on the Bristol Stool Form Scale. At 2 weeks postoperatively, most patients were satisfied with and still using their device.

There was no difference in median strain with the first bowel movement between the arms, defecation posture modification device versus usual care. Most patients found the device easy to use and planned to continue use.