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Ultrasound Obstet Gynecol. 2017 Mar;49(3):394-397. doi: 10.1002/uog.15828. Epub 2017 Jan 26.

The 'bother' of obstructed defecation.

Author information

1
Sydney Medical School Nepean, University of Sydney, Sydney, Australia.
2
Department of Obstetrics and Gynecology, University of Rochester, New York, NY, USA.
3
Departamento de Ginecología y Obstetricia, Clínica Alemana de Santiago-Universidad del Desarrollo, Chile.

Abstract

OBJECTIVE:

To examine the relationship of visual analog scale (VAS) 'bother' scores for obstructed defecation (OD) with demographic data, physical examination and sonographic findings of the posterior compartment.

METHODS:

All patients seen at a urogynecology clinic between January and October 2013 were included. Patients were diagnosed with OD if they had any of the following: incomplete bowel emptying, straining with bowel movement or need for digitation. Patients used a VAS to rate OD bother on a scale of 0-10 (0, no bother; 10, worst imaginable bother). For each patient, a comprehensive history was obtained, the International Continence Society Pelvic Organ Prolapse Quantification was performed and four-dimensional translabial ultrasound volumes were recorded on maximal Valsalva maneuver. Linear and multiple regression models were used to correlate bother VAS scores with demographic, clinical and sonographic findings.

RESULTS:

Among 265 patients included in the analysis, 61% had OD symptoms with a mean VAS bother score of 5.6. OD bother scores were associated with a history of previous prolapse surgery (P = 0.0001), previous hysterectomy (P = 0.0006), descent of the posterior compartment (Bp; P = 0.004) and hiatal dimensions (Pb and Gh + Pb; P = 0.006 and P = 0.004). OD bother was associated with the following sonographic findings: true rectocele (P = 0.01), depth of rectocele (P = 0.04), descent of rectal ampulla (P = 0.02), enterocele (P = 0.03) and rectal intussusception (P < 0.0001).

CONCLUSIONS:

VAS bother scores are associated with both clinical and sonographic measures of posterior compartment descent. Rectal intussusception was most likely to result in highly bothersome symptoms of OD. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

KEYWORDS:

obstructed defecation; posterior compartment; rectal intussusception; rectocele; translabial ultrasound; visual analog scale

PMID:
26611759
DOI:
10.1002/uog.15828
[Indexed for MEDLINE]
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