Anorectal function testing and anal endosonography in the diagnostic work-up of patients with primary pelvic organ prolapse.
OBJECTIVE
To study the pathophysiology of defecation disorders in patients with primary pelvic organ prolapse (POP) and the diagnostic potential of anorectal function testing (AFT) including endosonography in the work-up of these patients.


METHODS
59 Patients were evaluated with a validated questionnaire, clinical examination, AFT and endosonography.


RESULTS
Women with POP showed lower squeezing pressure, postponed first sensation and desire, lower capacity and prolonged pudendal nerve terminal latency time compared to healthy controls (all p < 0.01). Manometric findings did not differ significantly between patients with and without constipation. Patients with fecal incontinence had significantly lower resting and squeezing pressures than patients without fecal incontinence and an increased risk of an external sphincter defect (odds ratio = 12.75, 95% confidence interval 2.40-66.67). Although digital rectal examination could quantify absent, decreased and normal squeezing pressure, the positive predictive value for external sphincter defects was low (0.32).


CONCLUSIONS
AFT indicates the presence of neuromuscular damage of the anorectal region in patients with POP. AFT is not useful in the work-up of patients with POP and constipation, because it fails to discriminate between symptomatic and asymptomatic patients. In cases of fecal incontinence, AFT and endosonography are helpful to distinguish between functional and anatomical problems.
Groenendijk
Annette G
AG
Department of Gynecology and Obstetrics, Onze Lieve Vrouwe Hospital, Amsterdam, The Netherlands. a.g.groenendijk@olvg.nl
Birnie
Erwin
E
Boeckxstaens
Guy E
GE
Roovers
Jan-Paul W
JP
Bonsel
Gouke J
GJ
D003672:Defecation; D003937:Diagnosis, Differential; D051517:Digital Rectal Examination; D019160:Endosonography; D005260:Female; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D012002:Rectal Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D014596:Uterine Prolapse / Q000150:complications / Q000000981:diagnostic imaging*