Bowel symptoms 1 year after surgery for prolapse: further analysis of a randomized trial of rectocele repair.
OBJECTIVE
The purpose of this study was to analyze change in bowel function and its relationship to vaginal anatomy 1 year after rectocele repair and pelvic reconstruction in a randomized trial of 3 techniques of rectocele repair.


METHODS
The study is an ancillary analysis of data from a randomized trial of 3 techniques of rectocele repair: posterior colporrhaphy, site-specific repair, and site-specific repair with Fortagen graft augmentation. Pelvic examination and validated questionnaires were obtained at baseline, 6 months, and 1 year after surgery. Bowel symptoms included straining, splinting, incomplete emptying, painful defecation, fecal urgency, and fecal incontinence. Logistic regression was used to identify predictors of bothersome postoperative symptoms.


RESULTS
One hundred six women with Stage > or = 2 POP, which included a rectocele, were enrolled in the study. Ninety-nine underwent prolapse surgery that included a rectocele repair and completed at least 1 follow-up visit. Ninety-six percent of subjects underwent concomitant prolapse surgery. No differences in change in bowel symptoms were noted between treatment groups. On average, all bowel symptoms evaluated were significantly improved 1 year after surgery. The development of new "bothersome" bowel symptoms after surgery was uncommon (11%). After controlling for age, treatment group, comorbidities, and preoperative bowel symptoms, corrected postoperative vaginal support (Stage 0/1) was associated with a reduced risk of postoperative straining (adj. OR 0.17 95% CI 0.03 to 0.9) and feeling of incomplete emptying (adj. OR 0.1 95% CI 0.01 to 0.52). Normal support of the posterior vaginal wall (Bp < or = -2) was associated with a reduced risk of bothersome incomplete emptying (OR 0.08 95% CI 0.004 to 0.58) but not with other symptoms.


CONCLUSIONS
Resolution or improvement in bowel symptoms can be expected in the majority of women after rectocele repair and pelvic reconstruction. While all symptoms improved after surgery, a reduction in bothersome postoperative straining and incomplete emptying were specifically associated with cure of posterior vaginal wall prolapse.
Gustilo-Ashby
A Marcus
AM
Section of Urogynecology and Reconstructive Pelvic Surgery, Division of Surgery, Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, OH, USA.
Paraiso
Marie Fidela R
MF
Jelovsek
John Eric
JE
Walters
Mark D
MD
Barber
Matthew D
MD
D003672:Defecation; D013505:Digestive System Surgical Procedures; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D012005:Rectal Prolapse / Q000150:complications / Q000601:surgery*; D020047:Rectocele / Q000150:complications / Q000601:surgery*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000150:complications / Q000601:surgery*