Posterior vaginal wall prolapse does not correlate with fecal symptoms or objective measures of anorectal function

Abstract

Objective: The purpose of this study was to evaluate the relationship among the degree of posterior vaginal wall prolapse, anorectal symptoms, and physiology.

Study design: This was a prospective study that included patients with fecal dysfunction and prolapse/urinary symptoms. A validated instrument for fecal incontinence and the ROME II criteria were used. Anal physiologic testing was performed selectively on the basis of bowel symptoms. Patients were divided into 2 groups by pelvic organ prolapse quantification score clinical examination: group I: Ap/Bp < -1, and group II: Ap/Bp > or = -1. The association among the degree of prolapse, bowel symptoms, and physiologic findings was examined with the use of Fisher's exact test and logistic regression models.

Results: One hundred thirty-two patients with a mean age of 63 years (range, 24-90 years) were evaluated. There were 62 patients (47%) in group I and 70 patients (53%) in group II. Overall, 40.9% of the patients had constipation/obstructed defecation, and 25% of the patients had fecal incontinence. Ninety-seven patients underwent physiologic testing. At manometry, both resting and squeeze pressures were significantly higher in patients in group II. Overall, patients with a higher resting pressure (P = .001) and increased rectal capacity (P = .008) were more likely to be continent, and patients with a lower squeeze pressure were more likely to be incontinent (P = .001). Ultrasonography demonstrated anterior sphincter defect in 21.9% of the patients and a perineal body of <10 mm in 35.6% of the patients, with no correlation with the degree of prolapse. Patients with sphincter defects were 3 times more likely to have fecal incontinence (95% CI, 1.03, 8.75; P = .04). There was no association between electromyography and pudendal nerve terminal latencies and the degree of prolapse. Patients with prolonged pudendal nerve terminal latencies were more likely to be incontinent (P = .033). On defecography, 28% of the patients had concomitant enterocele, and 21.3% of the patients had intussusception, which was not detected by physical examination.

Conclusion: Anorectal symptoms do not correlate with the degree of posterior vaginal wall prolapse, nor does the presence of prolapse equate to abnormal physiologic test results. Bowel symptoms may result from primary anorectal abnormalities, which are demonstrated by physiologic studies.