Study of posterior vaginal wall prolapses and correlation with bowel function

Abstract

INTRODUCTIONProlapse though not life threatening condition, severely affect quality of life in women causing physical, social, psychological, occupational, domestic limitations. 1 The incidence of urogenital prolapse increases with advancing age, menopause and parity.2 It is estimated that 50% of parous women lose pelvic floor support and, as a result, develop prolapse, but only 20% of these women are symptomatic. Anorectal dysfunction is probably less understood pelvic symptom in women with prolapse.These patients may experience pain with defecation, the need to splint or strain to have a bowel movement or anal incontinence. Meschia found a 2-fold increased risk of anal incontinence in patients with a rectocele greater than grade 2. Surgery is the definitive treatment.It is estimated that the lifetime risk of undergoing at least one surgical procedure for prolapse is 11% and the reoperation rate for recurrent prolapse is 30-40%. 3 The surgical indication should be based on the individual's symptoms rather than the degree of vaginal wall prolapse. ABSTRACTBackground: This study's objectives were to describe symptoms related to bowel symptoms in women with prolapse and to compare these symptoms as per the grading of posterior vaginal prolapse. Methods: Descriptive study, 63 women answered questionnaire for assessment of bowel function and were subjected to physical examination according to the International Continence Society's system for grading uterovaginal prolapse. Results: The distribution of pelvic organ support by overall POPQ stage was 6.4%stage 1,21%stage 2, 50% stage 3, and 23% stage 4. Women were asked to rate the extent to which they were bothered by their bowel function on a scale of 1 to 10, with 1 being not at all and 10 being extremely. Thirty-six women (58%) reported 1 to 4, 18 (29%) reported 5 to 7, and 8 (13%) reported greater than 8. According to the furthest extent of posterior vaginal prolapse at point Bp, 22 (15.5%) were in stage 0, 46 (32.4%) were in stage I, 50 (35.2%) were in stage II, 23 (16.2%) were in stage III, and 1 (0.7%) was in stage IV. Ninety-two percent of women reported having bowel movements at least every day. When asked whether straining was required for them to have a bowel movement, 67% reported never or rarely,3% reported sometimes,1.6%) reported always. When asked whether they ever needed to help stool come out by pushing with a finger in the vagina or rectum, 77.0% reported never or rarely, 15.1% reported sometimes, (5.6%) reported usually, and (1.6%) reported always. No women had fecal incontinence, there were no clinically significant associations between any of the questions related to bowel function and severity of posterior vaginal prolapse. Conclusions: Women with uterovaginal prolapse frequently have symptoms related to bowel dysfunction but this is not associated with the severity of posterior vaginal prolapse.