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Prevalence of Defecatory Dysfunction in Women With and Without Pelvic Floor Disorders

Whitcomb, Emily L. MD*; Lukacz, Emily S. MD*; Lawrence, Jean M. ScD, MPH, MSSA; Nager, Charles W. MD*; Luber, Karl M. MD

Female Pelvic Medicine & Reconstructive Surgery: July-August 2009 - Volume 15 - Issue 4 - p 179-187
doi: 10.1097/SPV.0b013e3181b12e01
Original Article

Objective: To estimate the prevalence of defecatory dysfunction, and assess how defecatory dysfunction is associated with pelvic floor disorders such as pelvic organ prolapse, stress urinary incontinence, overactive bladder, and anal incontinence.

Methods: The Epidemiology of Prolapse and Incontinence Questionnaire assessed pelvic floor disorders and defecatory symptoms, including difficulty having a bowel movement and/or needing to push on the vagina or around the rectum to have or complete a bowel movement (splinting). Defecatory dysfunction was defined as having either difficulty having a bowel movement and/or splinting at least once per week. χ2 and Mann Whitney U tests were used to compare rates of defecatory dysfunction in women with and without pelvic floor disorders, and ANOVA used to compare mean visual analog scores across symptom frequency. Logistic regression assessed the relative impact of pelvic floor disorders on defecatory dysfunction.

Results: The prevalence of defecatory dysfunction was 20%. Among women with pelvic floor disorders, the prevalence of defecatory dysfunction was 60%, compared with 32% of unaffected women (P < 0.001). Mean degree of bother related to defecatory dysfunction increased linearly with frequency of symptoms (P < 0.001). In multivariate analysis, defecatory dysfunction was associated with (odds ratio, 95% confidence interval) neurologic disease (4.45, 2.41–8.19), pelvic floor disorders (2.72, 2.20–3.35), depression (1.53, 1.20–1.95), pulmonary disease (1.42, 1.07–1.89), and pelvic surgery (1.41, 1.10–1.81).

Conclusions: Twenty percent of community-dwelling women suffer from defecatory dysfunction. Because it is common and associated with pelvic floor disorders and other comorbidities, providers caring for affected women should perform a thorough pelvic floor evaluation.

Defactory dysfunction is common in community dwelling women and is highly associated with pelvic floor disorders.

From the *Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Reproductive Medicine, University of California, San Diego, CA; †Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA; and ‡Department of Female Pelvic Medicine and Reconstructive Surgery, Kaiser Permanente San Diego Medical Center, San Diego, CA.

Supported by NICHD grant R01 HD4113–01A1.

Reprints: Emily S. Lukacz, MD, MAS, 9350 Campus Point Drive, No. 0974, La Jolla, CA 92037. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.