Clinical study of pelvic organ prolapse about anorectal dynamics

Abstract

Objective To study the symptoms, and anorectal dynamics in women with pelvic organ prolapse (POP), so as to comprehensively assess anorectal dysfunction in POP. Methods A total of 59 cases of postmenopausal patients with POP in Shenzhen people′s Hospital from November 2011 to March 2013 were included in the POP group, at the same time 46 cases of postmenopausal patients without POP in the same hospital were included as control group. They were evaluated with a validated questionnaire (Colorectal-anal Distress Inventory 8), and anorectal manometry to assess the anorectal dysfunction of POP. The study followed the ethical standards of the human trials of the Shenzhen People′s Hospital, approved by the committee, and clinical research informed consent was signed by each patient. Results ①There were no statistically significant differences between two groups among age, gravidity, parity, the duration of menopause, and body mass index (P>0.05). ②There were no statistically significant differences between the POP patients of anterior vaginal wall prolapse Ⅱ degree+ Ⅲ degree and Ⅳ degree, uterus prolapse Ⅰ-Ⅲ degree and Ⅳ degree, posterior vaginal wall prolapsed Ⅰ degree+ Ⅱ degree and Ⅲdegree+ Ⅳ degree among resting and squeezing pressure and the rectum capacity of minimal sensation, normal defecation and strong defecation (P>0.05). ③There were bigger rectum capacity of normal defecation and stronger defecation in POP patients with difficult defecation than those of patients without difficult defecation, and the differences were statistically significant (t=4.93, 4.67; both P=0.000). But there were no statistically significant differences between the two groups among resting and squeezing pressure and the rectum capacity of minimal sensation (P>0.05). ④A total of 115 sets of Colorectal-anal Distress Inventory 8 questionnaires were handed out to POP group and control group, and 115 sets of valid questionnaires were collected, the feedback rate of the questionnaires were 100%. The POP group got more scores in questionnaires than control group, and the difference was statistically significant (t=4.81, P=0.000). ⑤There were lower resting and squeezing pressure in POP patients than those in control group, and the differences were statistically significant (t=3.15, 3.43; P=0.002, 0.001). There were bigger rectum capacity of minimal sensation, normal defecation and stronger defecation in POP patients than those in control group, and the differences wre statistically significant (t=3.42, 3.95, 3.83; P=0.001, 0.000, 0.000). Conclusions Patients with POP is often associated with a variety of symptoms, including difficult defecation, fecal incontinence endless defecate, which lead to the lower quality of life. The anorectal contraction and sensory function are decreased in patients with POP, but they are not associated with the degree of posterior vaginal wall prolapsed, but with the POP with difficulty defecating or not. Key words: Pelvic organ prolapse; Clinical symptoms; Anorectal manometry; Women, postmenopause