The role of parity and hysterectomy on the development of pelvic floor abnormalities revealed by defecography.
OBJECTIVE
The purpose of our study was to assess the role of multiparity and pelvic surgery, especially hysterectomy, on pelvic floor dysfunction as diagnosed on defecography.


METHODS
Three hundred fifty-four women who underwent defecography between 1986 and 1996 were asked to provide information regarding obstetric history and pelvic surgery. Responses were obtained from 272 women (response rate, 77%). Their presenting symptoms ranged from incontinence to constipation and obstructed defecation. Historical data were correlated with incidence of defecographic abnormalities that included rectocele, enterocele, rectal prolapse, incontinence, excessive pelvic floor descent, and dyskinetic puborectal muscle.


RESULTS
Women with three or more birth deliveries were more likely to have incontinence (48% versus 36%, p = .05) and excessive pelvic floor descent (26% versus 17%, p = .07) than women who had delivered fewer children. Women undergoing hysterectomy before defecography were more likely to have enterocele (40% versus 25%, p = .009) and excessive pelvic floor descent (25% versus 15%, p = .04) than women who had never undergone hysterectomy.


CONCLUSIONS
Our findings confirm the common belief that trauma from childbirth or hysterectomy contributes to the development of defecation disorders.
Karasick
S
S
Department of Radiology, Thomas Jefferson University Hospital, Jefferson Medical College, Philadelphia, PA 19107, USA.
Spettell
C M
CM
D019841:Defecography; D005242:Fecal Incontinence / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D006547:Hernia / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D008875:Middle Aged; D010298:Parity; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000503:physiopathology; D012002:Rectal Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D012005:Rectal Prolapse / Q000000981:diagnostic imaging / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors