Rectal evacuatory dysfunction in patients with genital prolapse

Fomenko O.Yu.

Moscow Regional Research Institute of Obstetrics and Gynecology, Ministry of Health of the Moscow Region, Moscow, Russia

Shelygin Yu.A.

A.N. Ryzhikh State Research Center of Coloproctology, Ministry of Health of Russia;
Department of Coloproctology, Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia

Popov A.A.

Moskovskiĭ oblastnoĭ NII akusherstva i ginekologii

SPIN RSCI: 5452-6728
Scopus AuthorID: 56720739500

Kozlov V.A.

Institute of Demography, National Research Institute «Higher School of Economics», Government of the Russian Federation, Moscow, Russia

Fedorov A.A.

Moskovskiĭ oblastnoĭ NII akusherstva i ginekologii

Belousova S.V.

Efremova E.S.

Moscow Regional Research Institute of Obstetrics and Gynecology, Ministry of Health of the Moscow Region, Moscow, Russia

Rectal evacuatory dysfunction in patients with genital prolapse

Authors:

Fomenko O.Yu., Shelygin Yu.A., Popov A.A., Kozlov V.A., Fedorov A.A., Belousova S.V., Efremova E.S.

More about the authors

Journal: Russian Bulletin of Obstetrician-Gynecologist. 2018;18(5): 67‑72

DOI: 10.17116/rosakush20181805167

Downloaded: 18

Download PDF (RU)

Contact the author

Table of contents

To cite this article:

Fomenko OYu, Shelygin YuA, Popov AA, Kozlov VA, Fedorov AA, Belousova SV, Efremova ES. Rectal evacuatory dysfunction in patients with genital prolapse. Russian Bulletin of Obstetrician-Gynecologist. 2018;18(5):67‑72. (In Russ.)
https://doi.org/10.17116/rosakush20181805167

Подписка 2025 (Russian Bulletin of Obstetrician-Gynecologist)

Использование инфографики авторами научных работ

Close metadata

Recommended articles:

Pelvic organ prolapse in young women. Russian Bulletin of Obstetrician-Gynecologist. 2023;(6-2):142-148

Monocytic profile of patients after pelvic floor reconstruction. Russian Bulletin of Obstetrician-Gynecologist. 2024;(4):29-34

Prolongation of the pelvic organs. Literature review. Russian Journal of Human Reproduction. 2024;(2):122-129

Objective — to identify whether functional defecation disorders may be present in patients with genital prolapse. Subject and methods. Forty patients with symptoms of pelvic floor muscle failure were examined. Their mean age was 56.6±9.5 years. One, two, three or more births were observed in 13 (32.5%), 24 (60%), and 3 (7.5%) patients, respectively. All the patients complained of difficult rectal evacuation, who met the 2016 Rome IV criteria for functional constipation. Group 1 comprised 29 (72.5%) women who had not been operated on; among whom there were 17 patients with complete metrocolpocele and 12 with vaginal wall prolapse (cystocele and/or rectocele); Group 2 consisted of 11 (27.5%) of patients with previous hysterectomy; among them there were 5 with vaginal vault prolapse and 6 vaginal wall prolapse (cystocele and/or rectocele). Results. High-resolution manometry identified that in Group 1 there were functional defecatory disorders in 20 (68.9%) cases: 12 patients with complete metrocolpocele and 8 with cystocele and/or rectocele. No functional defecatory disorders were recorded in 9 (31.1%) patients: 5 patients with complete metrocolpocele and 4 with cystocele and/or rectocele. Among Group 2 patients, these disorders were detected in 8 patients: 4 with complete metrocolpocele and 4 with cystocele and/or rectocele. There were no functional defecatory disorders in 3 cases: 1 patient with complete metrocolpocele and 2 patients with cystocele and/or rectocele. Conclusion. Rectal evacuatory dysfunction in patients with genital prolapse is due not only to organic causes as pelvic prolapse or descent, but also to the presence of instrumentally confirmed functional defecatory disorders in 70% of cases. There are minimal differences in the rate of functional defecatory disorders in patients with genital prolapse in the presence of the uterus and in those after hysterectomy (Pearson’s test, p=0.817; Fisher’s bilateral exact test, p=0.57). There were no significant differences in the number of cases of functional defecatory disorders in patients with complete metrocolpocele and vaginal wall prolapse (cystocele and/or rectocele); Pearson’s χ2; p=0.677; Fisher’s bilateral exact test, p=0,471.

Keywords:

genital prolapse

pelvic floor muscle failure

obstructive defecation

functional defecatory disorders

high-resolution anorectal manometry

evacuation test

Authors:

Fomenko O.Yu.

Moscow Regional Research Institute of Obstetrics and Gynecology, Ministry of Health of the Moscow Region, Moscow, Russia

Shelygin Yu.A.

Popov A.A.

Moskovskiĭ oblastnoĭ NII akusherstva i ginekologii

SPIN RSCI: 5452-6728
Scopus AuthorID: 56720739500

Kozlov V.A.

Institute of Demography, National Research Institute «Higher School of Economics», Government of the Russian Federation, Moscow, Russia

Fedorov A.A.

Moskovskiĭ oblastnoĭ NII akusherstva i ginekologii

Belousova S.V.

Efremova E.S.

Moscow Regional Research Institute of Obstetrics and Gynecology, Ministry of Health of the Moscow Region, Moscow, Russia

List of references:

Bezhenar VF, Bogatyreva EV, Pavlova NG. Prolapse of pelvic organs in women: etiology, pathogenesis, principles of diagnosis: manual for doctors. St-Petersburg: Publishing House N-L. 2010: 5. (In Russ.)
Aliev EA, Ahmedova EV. Prolapse of pelvic organs. Koloproktologiya. 2016;2:56:42-47. (In Russ.)
Pushkar DYu, Rasner PI, Gvozdev MYu. Genital prolapse. RMZh. Hirurgiya. Urologiya. 2013;34:11-13. (In Russ.)
Shelygin YuA, Vasil’ev SV, Grigor’ev EG, Esin VI, Zhukov BN, Zitta DV, Kashnikov VN, Kostarev IV, Kuzminov AM, Kulikovskii VF, Muravyov AV, Orlova LP, Pak VE, Plotnikov VV, Poletov NN, Temnikov AI, Timerbulatov VM, Titov AYu, Fomenko OYu, Frolov SA, Tikhonov AA, Khubezov DA, Chibisov GI, Yanovoi VV. AKR. Clinical guidelines. Kooproktologiya. Ed. Shelygin YuA. Moscow: GEOTAR-Media. 2015:528. (In Russ.)
Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A, Goldman HB, Huser M, Milani AL, Moran PA, Schaer GN, Withagen M. An International Urogynecological Association (IUGA)/International Continence Society (ICS). Joint Report on the Terminology for Female Pelvic Organ Prolapse (POP). Neurourology and Urodynamics. 2016;35:137-168. https://doi.org/10.1007/s00192-015-2932-1
DeLancey J. Anatomy and biomechanics of genital prolapse. Clinical Obstetrics and Gynecology. 1993;36:4:6:897-909. https://doi.org/10.1097/00003081-199312000-00015
Bezhenar VF, Ailamazyan EK, Rulev MV, Bogatyreva EV., Rusina EI, Kvetnoi IM, Kostyuchek IN, Mar’eva GG. The effectiveness of the system «PROLIFT-TOTAL» in the surgical treatment of decompensated forms of pelvic organ prolapse in women of reproductive age. Zhurnal akusherstva i zhenskih bolezney. 2011;1: LX:21-30. (In Russ.)
Kamoeva SV, Savchenko TN, Ivanova AV, Abaeva HA. Modern genetic aspects of pelvic organ prolapse in women. Akusherstvo, ginekologiya, reproduktsiya. 2013;1:7:17-21. (In Russ.)
Krasnopolskii VI, Buyanova SN, Shchukina NA, Popov AA. Operative gynecology. Moscow: Medpress-inform. 2010:320. (In Russ.)
Khitaran AG, Miziev IA, Dulerov KA. Tactics of surgical reconstruction of the pelvic floor in women with pelvic posterior prolapse. Annaly hirurgii. 2013;1:31-35 (In Russ.)
Popov AA, Krasnopolskaya IV, Tyurina SS, Manannikova TN, Fedorov AA, Ramazanov MR, Slobodyanyuk BA, Barto RA. Functional results of sacrospinal fixation in the treatment of patients with genital prolapse. Rossiiskii vestnik akushera-ginekologa. 2014;2:63-66. (In Russ.)
Tarabanova OV, Kravtsova NA, Miroshnichenko LB. Prolapse of the genitals: the current state of the problem. Zhurnal akusherstva I zhenskih bolezney (special issue). 2006:87-88. (In Russ.)
Kaiser AM. Colorectal surgery. Moscow: Panfilov’s Publishing House. 2011:192-197. (In Russ.)
Handa VL, Harvey L, Cundiff GW, Siddique SA, Kjerulff KH. Sexual function among women with urinary incontinence and pelvic organ prolapse. Am J Obstet Gynecol. 2004:191:751-756. https://doi.org/10.1016/j.ajog.2003.11.017
Weber AM, Walters MD, Piedmonte MR. Sexual function and vaginal anatomy in women before and after surgery for pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol. 2000;182:1610-1615. https://doi.org/10.1067/mob.2000.107436
Kahn MA, Stanton SL. Techniques of rectocele repair and their effects on bowel function. Int Urogynecol J. 1998;9:37-47.
Felt-Bersma RJF, Cuesta MA. Rectal prolapse, rectal intussusception, rectocele and solitary rectal ulcer syndrome. Gastroenterol Clin North Am. 2001;30:1:199-222.
Shelygin YuA, Titov AYu, Dzhanaev YuA, Biryukov OM, Mudrov AA, Krasnopol’skaya IV. Features of the clinical picture and the nature of neuro-functional disorders in patients with rectocele. Koloproktologiya. 2012;4:42:27-32. (In Russ.)
Block IR. Transrectal repair of rectocele using obliterative suture. Dis Colon Rectum. 1986;29:707-711. https://doi.org/10.1007/BF02555314
Savoye-Collet C, Savoye G, Koning E, Leroi A, Dacher J. Defecography in symptomatic older women living at home. Age and Ageing. 2003;32:347-350.
Rosen A. Obstructed defecation syndrome: diagnosis and Therapeutic options, with Special focus on the STARR Procedure. Isr Med Assoc J. 2010;12:2:104-106.
Bartolo CC, Roe AM, Virjee J, Mortensen NJ. Evacuation proctography in obstructed defaecation and rectal intussusception. BJS, Frontiers in Colorectal Disease. 1985;72:SI:111-116.
Fomenko OYu, Titov AYu, Biryukov OM, Mudrov AA, Belousova SV, Egorova DV. Diagnosis and conservative treatment of functional defecation disorders. Koloproktologiya. 2016;3:57:48-54. (In Russ.)
Higgins PD, Johanson JF. Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol. 2004;99:750-759. https://doi.org/10.1111/j.1572-0241.2004.04114.x
Preston DM, Lennard-Jones JE. Anismus in chronic constipation. Dig Dis Sci. 1985;30:5:413-418.
Rao SS, Welcher KD, Leistikow JS. Obstructive defecation: a failure of rectoanal co-ordination. Am J Gastroenterol. 1998;93:1042-1050. https://doi.org/10.1111/j.1572-0241.1998.00326.x
Schwandner O, Stuto A, Jayne D, Lenisa L, Pigot F, Tuech J, Scherer R, Nugent K, Corbisier F, Basany EE, Hetzer FH. Decision-making algorithm for the STARR procedure in obstructed defecation syndrome: position statement of the group of STARR Pioneers. Surg Innov. 2008;15:105-109. https://doi.org/10.1177/1553350608316684
Zhang B, Ding JH, Yin SH, Zhang M, Zhao K. Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception. World J Gastroenterol. 2010; 16:20:2542-2548. https://doi.org/10.3748/wjg.vl6.i20.2542
Fomenko OYu, Shelygin YuA, Poryadin GV, Titov AYu, Ponomarenko AA, Mudrov AA, Belousova SV. Functional state of pelvic floot muscles in patients with obstructive defecation syndrome. Koloproktologiya. 2017;2:60:55-61. (In Russ.)
Bharucha AE, Wald A, Enck P, Rao S. Functional anorectal Disorders. Gastroenterology. 2006;130:1510-1518. https://doi.org/10.1053/j.gastro.2005.11.064
Drossman DA. The functional gastrointestinal disorders and the Rome III. Gastroenterology. 2006;130:5:1377-1390. https://doi.org/10.1053/j.gastro.2006.03.008
Ellis CN, Essani R. Treatment of obstructed defecation. Clin Colon Rectal Surg. 2012;25:1:24-33. https://doi.org/10.1055/s-0032-1301756
Drossman DA. Functional Gastrointestinal disorders: History, Pathophysiology, Clinical Features, and Rome IV. Gastroenterology. 2016;150:1262-1279. https://theromefoundation.org/wp-content/uploads/Scoring-algorithm-for-the-Rome-IV- Diagnostic-Questionnaire-for-adults.pdf) https://doi.org/10.1053/j.gastro.2016.02.032
Shelygin YuA, Biryukov OM, Titov AYu, Mudrov AA, Fomenko OYu. Are there any predictors of the results of surgical treatment of rectocele? Koloproktologiya. 2015;1:51:64-69. (In Russ.)
Conklin J, Pimentel M, Soffer E. Color Atlas of High Resolution Manometry. Los Angeles. Springer: 2011:104. https://doi.org/10.1007/978-0-387-88295-6
Fomenko OYu, Shelygin YuA, Popov AA, Titov AYu, Belousova SV. Genital prolapse and obstructive defecation. From the point of view of functional diagnosis. Meditsinskii alfavit (Sovremennaya ginekologiya). 2017;3:1:39-44. (In Russ.)
Popov AA, Atroshenko KV, Fomenko OYu, Fyodorov AA, Manannikova TN, Tyurina SS, Koval AA, Barto RA, Golovin AA. Functional disorders of defecation in patients with genital prolapse. Condition before and after sakrokolpospeksii. Rossiiskii vestnik akushera-ginekologa. 2016;16:5:55-60. (In Russ.) https://doi.org/10.17116/rosakush201616555-60
Fomenko OYu, Shelygin YuA, Popov AA. Functional state of pelvic floor muscles in patients with rectocele. Rossiiskii vestnik akushera-ginekologa. 2017;17:3:43-48. (In Russ.) https://doi.org/10.17116/rosakush201717343-48
Golovenko AO, Fomenko OYu, Egorova DV. Therapy by the principle of «biofeedback» in the treatment of chronic constipation. Experimentalnay i klinicheskaya gastroenterologiya. 2017;139:3:99-105. (In Russ.)

Close metadata