title: The 'bother' of obstructed defecation.
abstract: OBJECTIVE
  To examine the relationship of visual analog scale (VAS) 'bother' scores for obstructed defecation (OD) with demographic data, physical examination and sonographic findings of the posterior compartment.
  
  
  METHODS
  All patients seen at a urogynecology clinic between January and October 2013 were included. Patients were diagnosed with OD if they had any of the following: incomplete bowel emptying, straining with bowel movement or need for digitation. Patients used a VAS to rate OD bother on a scale of 0-10 (0, no bother; 10, worst imaginable bother). For each patient, a comprehensive history was obtained, the International Continence Society Pelvic Organ Prolapse Quantification was performed and four-dimensional translabial ultrasound volumes were recorded on maximal Valsalva maneuver. Linear and multiple regression models were used to correlate bother VAS scores with demographic, clinical and sonographic findings.
  
  
  RESULTS
  Among 265 patients included in the analysis, 61% had OD symptoms with a mean VAS bother score of 5.6. OD bother scores were associated with a history of previous prolapse surgery (P = 0.0001), previous hysterectomy (P = 0.0006), descent of the posterior compartment (Bp; P = 0.004) and hiatal dimensions (Pb and Gh + Pb; P = 0.006 and P = 0.004). OD bother was associated with the following sonographic findings: true rectocele (P = 0.01), depth of rectocele (P = 0.04), descent of rectal ampulla (P = 0.02), enterocele (P = 0.03) and rectal intussusception (P < 0.0001).
  
  
  CONCLUSIONS
  VAS bother scores are associated with both clinical and sonographic measures of posterior compartment descent. Rectal intussusception was most likely to result in highly bothersome symptoms of OD. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Sydney Medical School Nepean, University of Sydney, Sydney, Australia.|Department of Obstetrics and Gynecology, University of Rochester, New York, NY, USA.
authors.forename: P
authors.initials: P
authors.lastname: Alam
authors.affiliation: Sydney Medical School Nepean, University of Sydney, Sydney, Australia.|Departamento de Ginecología y Obstetricia, Clínica Alemana de Santiago-Universidad del Desarrollo, Chile.
authors.forename: R
authors.initials: R
authors.lastname: Guzman Rojas
authors.affiliation: Sydney Medical School Nepean, University of Sydney, Sydney, Australia.
authors.forename: I
authors.initials: I
authors.lastname: Kamisan Atan
authors.affiliation: Sydney Medical School Nepean, University of Sydney, Sydney, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Mann
authors.affiliation: Sydney Medical School Nepean, University of Sydney, Sydney, Australia.
authors.forename: H P
authors.initials: HP
authors.lastname: Dietz
mesh_terms: D000328:Adult; D000368:Aged; D003248:Constipation / Q000453:epidemiology*; D003672:Defecation; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D021621:Imaging, Three-Dimensional; D007443:Intussusception / Q000150:complications*; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000453:epidemiology* / Q000601:surgery; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D064232:Visual Analog Scale
keywords: obstructed defecation; posterior compartment; rectal intussusception; rectocele; translabial ultrasound; visual analog scale