title: Effects of vaginal hysterectomy on anorectal sensorimotor functions--a prospective study.
abstract: BACKGROUND
  While bowel and bladder dysfunction are recognized consequences of a radical hysterectomy, the effects of a simple hysterectomy on anorectal sensorimotor functions, particularly rectal sensation, vary among studies and the effects on rectal compliance remain unknown. Our aims were to prospectively evaluate anorectal sensorimotor functions before and after a hysterectomy.
  
  
  METHODS
  Anal pressures, rectal compliance, capacity, sensation, and bowel symptoms were assessed before, at 2 months, and at 1 year after a simple vaginal hysterectomy for benign indications in 19 patients. Rectal staircase (0-44 mmHg, 4-mmHg steps), ramp (0-200 mL at 50, 200 and 600 mL min(-1)) and phasic distentions (8, 16, and 24 mmHg above operating pressure) were performed.
  
  
  RESULTS
  Anal resting (63 ± 4 before, 56 ± 4 mmHg after) and squeeze pressures (124 ± 12 before, 124 ± 12 mmHg after), rectal compliance and capacity (285 ± 12 before, 290 ± 11 mL 1 year after), and perception of phasic distentions were not different before vs after a hysterectomy. Sensory thresholds for first sensation and the desire to defecate were also not different, but pressure and volume thresholds for urgency were somewhat greater (Hazard ratio = 0.7, 95% CI [0.5, 1.0]) 1 year after (vs before) a hysterectomy. Rectal pressures were higher (P < 0.0001) during fast compared with slow ramp distention; this rate effect was greater at 1 year after a hysterectomy, particularly at 100 mL (P = 0.04).
  
  
  CONCLUSIONS
  A simple vaginal hysterectomy has relatively modest effects (i.e., somewhat reduced rectal urgency and increased stiffness during rapid distention) on rectal sensorimotor functions.
authors.affiliation: Clinical Enteric Neuroscience Translational and Epidemiological Research Program, Division of Gastroenterology and Hepatology, Department of Medicine, Rochester, MN, USA. bharucha.adil@mayo.edu
authors.forename: A E
authors.initials: AE
authors.lastname: Bharucha
authors.forename: C J
authors.initials: CJ
authors.lastname: Klingele
authors.forename: B M
authors.initials: BM
authors.lastname: Seide
authors.forename: J B
authors.initials: JB
authors.lastname: Gebhart
authors.forename: A R
authors.initials: AR
authors.lastname: Zinsmeister
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000502:physiology* / Q000503:physiopathology; D003672:Defecation / Q000502:physiology; D005242:Fecal Incontinence / Q000503:physiopathology; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects*; D008365:Manometry; D008875:Middle Aged; D059952:Pelvic Floor Disorders / Q000601:surgery; D011312:Pressure; D011446:Prospective Studies; D012007:Rectum / Q000502:physiology* / Q000503:physiopathology; D012677:Sensation / Q000502:physiology*; D012684:Sensory Thresholds / Q000502:physiology*