The Role of Parity and Hysterectomy on the Development of Pelvic Floor Abnormalities Revealed by Defecography

Abstract

OBJECTIVE. The purpose of our study was to assess the role of multiparity and pelvic surgery, especially hysterectomy, on pelvic floor dysfunction as diagnosed on defecography. MATERIALS AND METHODS. Three hundred fifty-four women who underwent defecography between 1986 and 1996 were asked to provide information regarding obstetric history and pelvic surgery. Responses were obtained from 272 women (response rate, 77%). Their presenting symptoms ranged from incontinence to constipation and obstructed defecation. Historical data were correlated with incidence of defecographic abnormalities that included rectocele, enterocele, rectal prolapse, incontinence, excessive pelvic floor descent, and dyskinetic puborectal muscle. RESULTS. Women with three or more birth deliveries were more likely to have incontinence (48% versus 36%, p = .05) and excessive pelvic floor descent (26% versus 17%, p = .07) than women who had delivered fewer children. Women undergoing hysterectomy before defecography were more likely to have enterocele (40% versus 25%, p = .009) and excessive pelvic floor descent (25% versus 15%, p = .04) than women who had never undergone hysterectomy. CONCLUSION. Our findings confirm the common belief that trauma from childbirth or hysterectomy contributes to the development of defecation disorders.