title: The prevalence of abnormal posterior compartment anatomy and its association with obstructed defecation symptoms in urogynecological patients.
abstract: OBJECTIVE
  Symptoms of obstructive defecation (OD) are common in women. Transperineal ultrasound (TPUS) has been used for the evaluation of defecatory disorders. The aim of our study was to determine the overall prevalence of anatomical abnormalities of the posterior compartment and their correlations with OD in women seen in a tertiary urogynecology clinic.
  
  
  METHODS
  This is a retrospective study on 750 women seen at a tertiary urogynecological unit who had undergone a standardized interview, clinical examination, and 4D TPUS. Univariate and multivariate logistic regression analyses were undertaken to study the association between examination findings and symptoms of OD. This study was approved by the local human research ethics committee (Nepean Blue Mountains Local Health District Human Research Ethics Committee, IRB approval no. 13-16).
  
  
  RESULTS
  The datasets of 719 women were analyzed. Mean age was 56.1 (18.4-87.6) years. Ninety-seven patients (13 %) reported fecal incontinence, 190 (26 %) constipation, and 461 (64 %) symptoms of OD. On examination, 405 women (56 %) were diagnosed with significant posterior compartment prolapse (POP-Q ≥ stage 2), which was associated with symptoms of OD (p < 0.0001). On ultrasound, 103 (14 %) patients had an enterocele, 382 (53 %) a true rectocele and 31 (4.3 %) had rectal intussusception. On multivariate analysis true rectocele (p = 0.003) and rectal intussusception (p = 0.004) remained significantly associated with symptoms of OD.
  
  
  CONCLUSIONS
  Both symptoms of OD and anatomical abnormalities of the posterior compartment are highly prevalent in urogynecological patients. Ultrasound findings of a true rectocele and rectal intussusception are significantly associated with obstructed defecation.
authors.affiliation: Department of Obstetrics, Gynecology and Neonatology, Sydney Medical School Nepean, University of Sydney, Penrith, Australia. rodrigoguzman.66@gmail.com.|Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Avenida Vitacura 5951, Vitacura, Santiago, Chile, 7650568. rodrigoguzman.66@gmail.com.|Departamento de Ginecología y Obstetricia, Hospital Clínico de la Universidad de Chile, Santiago, Chile. rodrigoguzman.66@gmail.com.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Guzman Rojas
authors.affiliation: Department of Obstetrics, Gynecology and Neonatology, Sydney Medical School Nepean, University of Sydney, Penrith, Australia.|Department of Obstetrics and Gynecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Ixora
authors.initials: I
authors.lastname: Kamisan Atan
authors.affiliation: Department of Obstetrics, Gynecology and Neonatology, Sydney Medical School Nepean, University of Sydney, Penrith, Australia.|Department of Obstetrics and Gynecology, Liverpool Clinical School, University of Western Sydney, Parramatta, Australia.
authors.forename: Ka Lai
authors.initials: KL
authors.lastname: Shek
authors.affiliation: Department of Obstetrics, Gynecology and Neonatology, Sydney Medical School Nepean, University of Sydney, Penrith, Australia.
authors.forename: Hans Peter
authors.initials: HP
authors.lastname: Dietz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003672:Defecation; D005260:Female; D005836:Genitalia, Female / Q000002:abnormalities* / Q000000981:diagnostic imaging; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D020047:Rectocele / Q000000981:diagnostic imaging / Q000209:etiology*; D012189:Retrospective Studies; D014463:Ultrasonography; D055815:Young Adult
keywords: Enterocele; Intussusception; Posterior compartment; Rectocele; Transperineal ultrasound