Types of pelvic floor dysfunctions in nulliparous, vaginal delivery, and cesarean section female patients with obstructed defecation syndrome identified by echodefecography

Abstract

The distribution of pelvic floor dysfunctions showed no specific pattern across the groups, suggesting the absence of a correlation between these dysfunctions and vaginal delivery.

Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions

“…In order to rule out vaginal delivery as a confounding factor in the observed positive association between older age and higher prevalence of posterior pelvic floor dysfunctions, we stratified the groups separately according to mode of delivery and parity. The prevalence of rectocele grade II or III, rectal intussusception and anismus was similar when comparing nulliparous women, subjects with vaginal delivery and subjects with cesarian section, despite the large number of patients over 50y with a history of vaginal delivery (group II), matching findings from other studies (17,20,27) . In addition, no relation was observed between the higher prevalence of significant rectocele and increasing number of vaginal deliveries.…”

“…However, rectocele grade II or grade III, rectal intussusception, rectocele grade II or III associated with rectal intussusception and occult sphincter injury were more prevalent in group II (P = 0.0432; P = 0.0028; P = 0.0178; P = 0.0001, respectively). The groups did not differ significantly with regard to anismus, anismus associated with rectocele grade II or III, or entero/ sigmoidocele grade III ( (8,14,15,17,20,27) . Thus, while some reports have correlated pelvic floor abnormalities with obstetric trauma (4,10,12,23) , others have failed to identify an association between the incidence of such dysfunctions and vaginal delivery (17,20,27) .…”

“…The groups did not differ significantly with regard to anismus, anismus associated with rectocele grade II or III, or entero/ sigmoidocele grade III ( (8,14,15,17,20,27) . Thus, while some reports have correlated pelvic floor abnormalities with obstetric trauma (4,10,12,23) , others have failed to identify an association between the incidence of such dysfunctions and vaginal delivery (17,20,27) . According to Dietz et al (6,7) true rectocele is a rectovaginal septum defect in younger nulliparous women, the prevalence and size of which appear to be associated with childbirth.…”

“…Different techniques and imaging methods have been used to evaluate pelvic floor dysfunctions in the anterior, middle and posterior compartment (2,3,7,8,9,12,14,15,16,17,18,19,20,24,25,27) . Because of differences in measurement techniques and anatomical landmarks, some authors describe rectocele as a descent of the rectal ampulla, quantified by correlation with the inferoposterior margin of the symphysis pubis (8,12) , while others consider rectocele a herniation of the anterior rectal wall into the posterior vagina, the size of which determines the grade of rectocele (2,3,9,13,15,17,19,20,23,27,29) .…”

“…Because of differences in measurement techniques and anatomical landmarks, some authors describe rectocele as a descent of the rectal ampulla, quantified by correlation with the inferoposterior margin of the symphysis pubis (8,12) , while others consider rectocele a herniation of the anterior rectal wall into the posterior vagina, the size of which determines the grade of rectocele (2,3,9,13,15,17,19,20,23,27,29) . Using 3-DAUS, we identified isolated and associated posterior dysfunctions and determined rectocele size.…”