GENITAL HIATUS AND PERINEAL BODYMEASURES: CORRELATION WITH DEFECATORY SYMPTOMS
L. S. BEZERRA1, J. A.VASCONCELOS NETO 2, C. VASCONCELOS 3, S. M.REGADAS 2, K. L. AUGUSTO 2, A. P. BILHAR 4,S. L. ARCANJO 2;
1Saúde Materno Infantil,Federal Univ. of Ceara, Fortaleza, Brazil, 2CIRURGIA,Federal Univ. of Ceara, Fortaleza, Brazil, 3Univ.e Federaldo Ceará, Fortaleza, Brazil, 4UNIFESP, Fortaleza, Brazil.
Introduction: Pelvic organprolapse (POP) may cause many symptoms that are commonly attributedto the anatomic compartments involved. Perineal and posterior POPhave often been associated with symptoms of defecatory dysfunction1Genital hiatus (Gh) and perineal body (Pb) as standardized measuresby POP-Q and correlation with bowel symptoms results varywidely
Objective: to evaluate the correlation of Pb, Gh andPb + Gh measures with constipation, anal incontinence, severity ofsymptoms and quality of life (QoL).
Methods: The patientswere distributed into 2 groups according to the posterior vaginalwall Bp point (POP-Q): One group without posterior vaginal wallprolapse (Control Group = Bp ≤ -1) and one with posterior vaginalwall prolapse (Case Group = Bp ≥ 0). Assessment of ObstructedDefecation was done by means of the Cleveland Clinic ConstipationScore (CCCS) and Assessment of Anal Incontinence by means of theCleveland Clinic Incontinence Score (CCIS). Demographic data,defecatory dysfunctions and SF-36 were compared between the groups.Differences between the groups regarding the continuous data wereassessed using either Student’s t-test (for normally distributeddata) or the Mann-Whitney U test (for non-parametric data).Correlations between severity of posterior prolapsePOP, severity ofobstructed defecation, anal incontinence and POP-Q measurements werecalculated using Spearman’s ρ (rho). Research Ethics Committee ofthe two Hospitals previously approved the clinical protocol, and allpatients signed the consent form.
Results: A total of 613women were evaluated, 439 who had anterior and apical POP larger thanthe posterior wall prolapse (C point or Ba point > Bp point) wereexcluded, as were those who had undergone gynecological (hysterectomyand/or surgery for urinary incontinence and genital prolapse) orcoloproctological surgery. 174 women were included (ControlGroup=69/39.7%, Case Group=105/60.3%). The groups were similar in thefollowing characteristics: anal incontinence, fecal urgency and/orconstipation. By analyzing the constipation and incontinence scores,it was observed that the groups were also similar in the CCCS(Control: 5.1; 95%CI: 3.4-6.8 x Case: 3.8; 95%CI: 2.5-5.0; p=0.242)and CCIS (Control: 1.4; 95%CI: 0.7-2.0 x Case: 1.3; 95%CI: 0.8-1.8;p=0.982). There were statistical differences between the groups whenthe Gh (Control: 4,0; range: 3,0-4,0 x Case: 5,0; range: 4,0-6,0;p=0,000), and Gh+Pb (Control: 7,0; range: 6,0-8,0 x Case: 8,0; range:7,0-9,0; p=0,000) measures were compared (Figure 2). There were apositive correlation between the measurements of Pb and Gh+Pb withthe constipation score (p = 0.00), however, there was no correlationbetween the Gh, Pb and Gh+Pb measurements with anal incontinence.There were no significant differences between in the global QoL(SF-36) score between the groups (Bp≤ -1: 49/69 vs. Bp≥0:71/105). However, there were correlations between the scores of somedomains (general health and pain) of the SF-36 QoL questionnaire andthe Gh+Pb measurers.
Conclusions: These data suggest thatthe severity of posterior vaginal wall prolapse does not correlatewith constipation and anal incontinence, The Pb and Gh+Pb correlatedpositively with symptoms of constipation, as well as with the scoresof some domains of the SF-36, however, there was no correlation withanal incontinence.
References: 1 - Collins SA, O'SullivanDM, Lasala CA. Correlation of POP-Q posterior compartment measureswith defecatory dysfunction. International urogynecology journal.2012 Jun;23(6):743-7. PubMed PMID: 22249278.