Functional bowel disorders and pelvic organ prolapse: a case-control study.
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2010-07
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OBJECTIVES: : To compare the relative frequencies of constipation and other functional bowel disorders between patients with and without pelvic organ prolapse (POP). METHODS: : This was a case-control study design. Cases were patients with stage 3-4 POP presenting to a urogynecology clinic and controls were patients presenting to a general gynecology or women's health clinic for annual examinations with stage 0-1 vaginal support. Constipation disorders were defined using responses to the Rome II Modular Questionnaire for functional bowel disorders as well as predefined defecatory disorders. RESULTS: : 128 cases and 127 controls were enrolled. After controlling for race, education, and comorbidities, women with POP were more likely to report symptoms consistent with outlet constipation, including straining during a bowel movement (odds ratio [OR] 3.9, confidence interval [CI] 2.1-7.3), feeling of incomplete rectal emptying (OR 4.0, CI 2.1-7.7), a sensation that stool cannot be passed (OR 3.4, CI 1.7-6.7), and splinting (OR 2.7, CI 1.3-5.7). In spite of this, cases were just as likely to meet the criteria for functional constipation or irritable bowel syndrome (IBS) with constipation as controls but more likely to meet the criteria for IBS-any type (OR 3.8, CI 1.6-9.1) as women with POP reported more discomfort or pain in the abdomen (OR 3.4 CI 1.6-7.1) and >3 bowel movements per day (OR 2.9, CI 1.3-6.3). CONCLUSIONS: : Patients with POP are more likely to have symptoms of outlet constipation and other functional bowel disorders compared with patients without POP. The Rome II criteria may not be an appropriate classification system for functional bowel disorders in patients with advanced POP.
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Jelovsek, John Eric, Mark D Walters, Marie Fidela R Paraiso and Matthew D Barber (2010). Functional bowel disorders and pelvic organ prolapse: a case-control study. Female Pelvic Med Reconstr Surg, 16(4). pp. 209–214. 10.1097/SPV.0b013e3181e4f270 Retrieved from https://hdl.handle.net/10161/15388.
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John E Jelovsek
Dr. Jelovsek is the F. Bayard Carter Distinguished Professor of OBGYN at Duke University and serves as Director of Data Science for Women’s Health. He is Board Certified in OBGYN by the American Board of OBGYN and in Female Pelvic Medicine & Reconstructive Surgery by the American Board of OBGYN and American Board of Urology. He has an active surgical practice in urogynecology based out of Duke Raleigh. He has expertise as a clinician-scientist in developing and evaluating clinical prediction models using traditional biostatistics and machine learning approaches. These “individualized” patient-centered prediction tools aim to improve decision-making regarding the prevention of lower urinary tract symptoms (LUTS) and other pelvic floor disorders after childbirth (PMID:29056536), de novo stress urinary incontinence and other patient-perceived outcomes after pelvic organ prolapse surgery, risk of transfusion during gynecologic surgery, and urinary outcomes after mid-urethral sling surgery (PMID: 26942362). He also has significant expertise in leading trans-disciplinary teams through NIH-funded multi-center research networks and international settings. As alternate-PI for the Cleveland Clinic site in the NICHD Pelvic Floor Disorders Network, he was principal investigator on the CAPABLe trial (PMID: 31320277), one of the largest multi-center trials for fecal incontinence studying anal exercises with biofeedback and loperamide for the treatment of fecal incontinence. He was the principal investigator of the E-OPTIMAL study (PMID: 29677302), describing the long-term follow up sacrospinous ligament fixation compared to uterosacral ligament suspension for apical vaginal prolapse. He was also primary author on research establishing the minimum important clinical difference for commonly used measures of fecal incontinence. Currently, he serves as co-PI in the NIDDK Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) (U01DK097780-05) where he has been involved in studies in the development of Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index-29 (LURN SI-29) and LURN SI-10 questionnaires for men and women with LUTS. He is also the site-PI for the PREMIER trial (1R01HD105892): Patient-Centered Outcomes of Sacrocolpopexy versus Uterosacral Ligament Suspension for the Treatment of Uterovaginal Prolapse.
Matthew Don Barber
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