OP28.08: Is abnormal posterior compartment anatomy associated with anal incontinence?

Abstract

It has been claimed that rectocele and intussusception are associated with anal incontinence, but this has not been studied while controlling for anal sphincter trauma. We aimed to investigate such a potential association in women with intact anal sphincter presenting with pelvic floor dysfunction. This is a retrospective study on 1314 women assessed at a tertiary urogynecological centre for pelvic floor dysfunction between 2014 and 2016. All had undergone a standardised physician-directed interview, clinical examination and transperineal 4D ultrasound (TPUS). The presence of intussusception was recorded during the examination, while descent of the rectal ampulla, rectocele, enterocele and anal sphincter trauma were measured offline. 181 women were excluded due to anal sphincter trauma (n=146) and incomplete data (n=35, leaving 1133. Mean age was 54.1 (17-89) years with mean BMI of 29.4 (15-68) kg/m2. Anal incontinence (AI) was reported by 149 (13%) patients, with a median St Mark's score (SMIS) of 12 (1-23). 638 (56%) patients had abnormal posterior compartment anatomy: 38% (n=425) showed significant descent of the rectal ampulla, 46% (n=527) a true rectocele, 8% (n=89) an enterocele and 2% (n=26) an intussusception. Table 1 shows associations between AI and these abnormalities. On adjusting for potential confounders, only the association between enterocele and AI appeared significant (OR 1.84 (1.07-3.16), p=0.026). In women without anal sphincter trauma, macroscopic anatomical abnormalities of the posterior compartment do not seem to be associated with anal incontinence, with the possible exception of enterocele.