Kahn Margie A, Breitkopf Carmen Radecki, Valley Michael T, Woodman Patrick J, O'Boyle Amy L, Bland Deirdre I, Schaffer Joesph I, Grady James J, Swift Steven E
Division of Benign Gynecology, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston 77555-0587, USA.
Am J Obstet Gynecol. 2005 May;192(5):1516-22. doi: 10.1016/j.ajog.2004.11.040.
The purpose of this study was to evaluate the association of constipation symptoms and anal incontinence with vaginal wall and pelvic organ descent in a general gynecologic population.
In this multicenter, cross-sectional study, 1004 women attending routine gynecologic healthcare underwent pelvic organ prolapse quantification (POPQ) measurements, and were surveyed regarding anal incontinence, digitation, < 2 bowel movements (BMs)/week, and > 25% frequency of: straining, hard/lumpy stools, and incomplete emptying. Constipation scores reflected the sum of positive responses. Associations between POPQ measurements (Ba, C, Bp, gh+pb), constipation scores, and anal incontinence were evaluated using multivariable regression.
Of 119 women with Bp > or = -1.00, 47% reported no constipation symptoms. Hard/lumpy stools (26%), incomplete emptying (24%), and straining (24%) were more prevalent; fewer women reported < 2 BMs/week (15%) or digitation (7%). Constipation scores were weakly correlated with Bp, gh+pb (both r < .1, P < .02). Women reporting > or = 2 symptoms had greater gh+pb measurements than women reporting 0 or 1 symptom (P = .03). Women with anal incontinence had greater gh+pb and gh values than women without anal incontinence (P < .01). POPQ measurements were regressed separately onto (1) total constipation scores, (2) dichotomized scores, and (3) individual symptoms, with BMI, age, number of vaginal deliveries (NVD), weight of largest vaginal delivery (WLVD), race, hysterectomy, study site, and income included as covariates. Total constipation scores and dichotomized scores were nonsignificant in all models. With regard to individual symptoms, straining at stool was significant in the models for Ba and gh+pb, with greater Ba and gh+pb measurements among strainers relative to nonstrainers.
Most associations between bowel symptoms and vaginal or pelvic organ descent were weak. After controlling for important covariates, straining at stool remained associated with anterior vaginal wall and perineal descent.
本研究旨在评估普通妇科人群中便秘症状及肛门失禁与阴道壁和盆腔器官脱垂的相关性。
在这项多中心横断面研究中，1004名接受常规妇科保健的女性接受了盆腔器官脱垂定量（POPQ）测量，并就肛门失禁、指诊、每周排便次数少于2次以及以下情况频率超过25%进行了调查：用力排便、大便干结/呈块状、排便不尽。便秘评分反映了阳性反应的总和。使用多变量回归评估POPQ测量值（Ba、C、Bp、gh+pb）、便秘评分和肛门失禁之间的相关性。
在119名Bp≥-1.00的女性中，47%报告无便秘症状。大便干结/呈块状（26%）、排便不尽（24%）和用力排便（24%）更为常见；较少女性报告每周排便次数少于2次（15%）或指诊（7%）。便秘评分与Bp、gh+pb呈弱相关（r均＜0.1，P＜0.02）。报告有2种及以上症状的女性gh+pb测量值高于报告0种或1种症状的女性（P = 0.03）。有肛门失禁的女性gh+pb及gh值高于无肛门失禁的女性（P＜0.01）。将POPQ测量值分别与（1）总便秘评分、（2）二分制评分和（3）个体症状进行回归分析，将体重指数、年龄、阴道分娩次数、最大阴道分娩体重、种族、子宫切除术、研究地点和收入作为协变量纳入。总便秘评分和二分制评分在所有模型中均无统计学意义。关于个体症状，在Ba和gh+pb模型中，用力排便具有统计学意义，用力排便者的Ba和gh+pb测量值高于非用力排便者。
肠道症状与阴道或盆腔器官脱垂之间的大多数相关性较弱。在控制重要协变量后，用力排便仍与阴道前壁和会阴脱垂相关。
