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


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.

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