Defecographic pelvic floor abnormalities in constipated patients: does mode of delivery matter?
BACKGROUND
The aim of this study was to demonstrate the distribution of defecographic pelvic floor abnormalities in constipated female patients and to correlate these dysfunctions with the mode of delivery.


METHODS
Two hundred and fifty-five female patients who underwent defecography for constipation from 2001 to 2008 were reviewed and pelvic floor abnormalities were assessed. The patients were divided into three groups: group I had 50 nulliparous women, mean age 40.2 (+ or - 15.3), group II had 165 vaginally parous women, mean age 57 (+ or - 13.3), and group III had 40 patients delivered by cesarean section, mean age 50.6 (+ or - 11.9).


RESULTS
Significant rectocele was identified in group I (36%), group II (35.8%), and group III (20%) without any statistically significant differences among the groups (p > 0.05). Intussusception was identified in group I (48%), group II (70.3%), and in group III (67.5%; p = 0.014). Intussusception associated with significant rectocele was more common in vaginally parous patients (p = 0.043). Abnormalities on puborectalis relaxation associated or not associated with rectocele were similar among the groups (p = 0.47). Vaginally parous patients had more abnormal exams as compared to other patients (p = 0.005). Significant rectocele was identified in (39%) patients with age > or = 50 years and in (26.3%) patients with age <50 years (p = 0.03).


CONCLUSIONS
There was no specific correlation between distribution of pelvic floor disorders and mode of delivery in this study. Patients of age greater than 50 years had a higher incidence of significant rectocele.
Murad-Regadas
Sthela
S
Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA.
Peterson
Thais V
TV
Pinto
Rodrigo A
RA
Regadas
F Sergio P
FS
Sands
Dana R
DR
Wexner
Steven D
SD
D000328:Adult; D000367:Age Factors; D000368:Aged; D002585:Cesarean Section / Q000706:statistics & numerical data; D003248:Constipation / Q000000981:diagnostic imaging / Q000453:epidemiology*; D019841:Defecography; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D008875:Middle Aged; D010298:Parity; D017773:Pelvic Floor / Q000000981:diagnostic imaging; D011247:Pregnancy; D020047:Rectocele / Q000453:epidemiology*; D012189:Retrospective Studies; D055815:Young Adult