Posterior Vaginal Wall Defects and Their Relation to Measures of Pelvic Floor Neuromuscular Function and Posterior Compartment Symptomatology

Drs. M. Fialkow, J. Melville, C. Gardella, D. Fenner

University of Washington Medical Center
Seattle, Washington

Objective : To describe the pelvic floor neuromuscular function and posterior compartment symptomatology in patients with and without posterior vaginal wall prolapse.

Methods :  Women referred to a Urogynecology & Female Urology clinic were enrolled.  Each patient completed a health history questionnaire including measures of bowel function and underwent standardized assessments of pelvic floor neuromuscular function and uterovaginal prolapse according to the Pelvic Organ Prolapse Quantification system (POP-Q).

Results :  One hundred and fourteen women completed questionnaires and had POP-Q data available for analysis.  Fifty-six had a POP-Q point Bposterior ≥ -1, by definition a minimum of stage II prolapse by POP-Q.  Older age (median 58yrs vs. 51, p=.02) was significantly associated with a point Bp≥-1, otherwise there were no significant demographic differences between the groups of women.  On physical exam a genital hiatus >3cm (44% vs, 19%; p<.01) and perineal descent > 2cm (17% vs. 4%; p=.03) were significantly more frequent in the patients with posterior prolapse.  A weak or absent kegel contraction and the presence or absence of a bulbocavernosus reflex were not significantly different between the groups.  The patients with posterior prolapse more frequently complained of an inability to defecate when stool was in the rectum (80% vs. 40%; p=.01).  All other measures of symptomatology, including fecal incontinence were not significantly different between the groups.  When women with posterior prolapse and complaints of defecatory dysfunction were compared to women with prolapse without defecatory dysfunction, only a genital hiatus > 3cm (65% vs.23%; p=.004) remained a significantly more common finding.

Conclusions :  Some measures of pelvic floor neuromuscular function appear related to posterior vaginal defects, however, only the genital hiatus appears strongly associated with posterior compartment symptomatology and prolapse.
Key Words :  Posterior Prolapse, Genital Hiatus, Defecatory Dysfunction