Back to all available

Characteristics and evolution of pelvic floor structures in female patients aged over 40 years with constipation - a cohort study

anatomy-and-physiology
gastroenterology-and-hepatology
gynecology-and-obstetrics
womens-health

Abstract

Background. Pelvic floor dysfunction (PFD) is a common cause of chronic constipation, which reciprocally can exacerbate pelvic floor burden. However, the characteristics and evolution of pelvic floor structures in patients with constipation remain unclear. This study investigates the characteristics and evolution of pelvic floor structures in female patients aged over 40 years with constipation.

Methods. Clinical data were collected from female patients undergoing pelvic floor ultrasound at the Third Affiliated Hospital of Sun Yat-sen University from December 2020 to August 2023. Propensity score matching (PSM) minimized confounders between the constipation (n=247) and non-constipation (n=898) groups. Differences in ultrasound data between the two groups and changes in pelvic floor structure over time in constipation patients were analyzed.

Results. Significant intergroup differences emerged in uterine prolapse (P=0.042), rectocele (P=0.022), levator ani hiatus dilation (P=0.013), hiatus area (P=0.003), the position of the uterus (P=0.001), and rectal ampulla (P=0.017) at maximal Valsalva maneuver (VM). Multivariate analysis identified rectocele (P=0.023) and uterine descent at maximal VM (P=0.026)as being positively associated with the occurrence of constipation. Multiple ultrasonographic evaluations over two years revealed stable pelvic floor anatomy in non-constipated individuals but identified alterations in 78 patients with constipation, including increased vesicocele (P=0.039), uterine prolapse (P=0.019), perineal hypermobility (P=0.015), lower bladder (P ＜ 0.001) and rectal ampulla (P=0.001) positions at maximal VM, greater bladder descent (P=0.001), and enlarged hiatus area (P=0.001).

Conclusion. This study demonstrates that rectocele and uterine descent at maximal VM exhibit positive associations with constipation presence. Over time, further descent of the bladder, uterus, and rectum occurs in female patients with constipation, along with an increase in perineal mobility and levator ani hiatus area.

Ask to review this manuscript

Notes for potential reviewers

  • Volunteering is not a guarantee that you will be asked to review. There are many reasons: reviewers must be qualified, there should be no conflicts of interest, a minimum of two reviewers have already accepted an invitation, etc.
  • This is NOT OPEN peer review. The review is single-blind, and all recommendations are sent privately to the Academic Editor handling the manuscript. All reviews are published and reviewers can choose to sign their reviews.
  • What happens after volunteering? It may be a few days before you receive an invitation to review with further instructions. You will need to accept the invitation to then become an official referee for the manuscript. If you do not receive an invitation it is for one of many possible reasons as noted above.
  • PeerJ does not judge submissions based on subjective measures such as novelty, impact or degree of advance. Effectively, reviewers are asked to comment on whether or not the submission is scientifically and technically sound and therefore deserves to join the scientific literature. Our Peer Review criteria can be found on the "Editorial Criteria" page - reviewers are specifically asked to comment on 3 broad areas: "Basic Reporting", "Experimental Design" and "Validity of the Findings".
  • Reviewers are expected to comment in a timely, professional, and constructive manner.
  • Until the article is published, reviewers must regard all information relating to the submission as strictly confidential.
  • When submitting a review, reviewers are given the option to "sign" their review (i.e. to associate their name with their comments). Otherwise, all review comments remain anonymous.
  • All reviews of published articles are published. This includes manuscript files, peer review comments, author rebuttals and revised materials.
  • Each time a decision is made by the Academic Editor, each reviewer will receive a copy of the Decision Letter (which will include the comments of all reviewers).

If you have any questions about submitting your review, please email us at [email protected].