Women With More Severe Chronic Constipation Have More Urogenital Symptoms
- This retrospective study of women with pelvic floor disorders determined whether constipated patients had an increased rate of urinary symptoms and whether the prevalence of those symptoms varied depending on constipation severity
- Women with chronic constipation were significantly more likely than those without to report painful intercourse, urinary hesitancy, sensation of poor bladder emptying and the need to lift the bladder by vaginal manipulation to initiate or complete a void
- Patients with the highest scores on the Constipation Severity Instrument had higher scores on the Urinary Distress Inventory Short Form, an instrument that assesses a variety of urinary symptoms
- Women who very frequently strained during defecation were more likely than others to report nocturia and a sensation of incomplete bladder emptying
- Clinicians should question women with chronic idiopathic constipation about possible coexisting urogenital symptoms
Women with chronic constipation often experience concurrent urogenital symptoms associated with pelvic floor dysfunction. Researchers at Massachusetts General Hospital have conducted a detailed study of this relationship.
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Milena M. Weinstein, MD, and Liliana G. Bordeianou, MD, MPH, co-directors of the Center for Pelvic Floor Disorders in the Department of Obstetrics and Gynecology, Marcus V. Ortega, MD, attending physician in the department, and colleagues present the findings in Techniques in Coloproctology.
The team retrospectively analyzed data on 1,471 adult women seen at the Center for Pelvic Floor Disorders between May 2007 and August 2019. At their initial visit, patients completed the:
- Constipation Severity Instrument (CSI), a 17-item questionnaire with three separately measurable subscales (obstructive defecation, colonic inertia, and pain); the maximum score is 73 points
- Urinary Distress Inventory Short Form (UDI-6), which assesses a variety of urinary symptoms such as urine leakage, difficulty with bladder emptying, pain, different types of urinary incontinence, and degree of symptom bother
875 women (59.5%) reported chronic constipation. They were divided into "High CSI" (those with a score more than the 75th percentile of 43 points) and "Low CSI."
Women With Vs. Without Constipation
Women with constipation were more likely than those without to report:
- Painful intercourse—43% vs. 35% (P=0.03)
- Urinary hesitancy and sensation of incomplete bladder emptying—27% vs.17% (P<0.001)
- Bladder splinting (lifting the bladder by vaginal manipulation to initiate or complete voiding)—13% vs. 8% (P< 0.001)
High CSI vs. Low CSI
Compared to women with a low CSI score, women with the highest constipation severity:
- Had a higher mean UDI-6 score—10.9 vs. 9.4 (P=0.01)
- Were more likely to report bladder splinting—21% vs. 11% (P<0.001)
- Were more likely to report painful intercourse—52% vs. 40% (P=0.03)
On multivariate analysis, urogenital symptoms associated with a high CSI score were:
- Bladder splinting—adjusted OR (aOR), 2.00 (P=0.001)
- Painful intercourse—aOR, 1.62 (P=0.033)
- Higher UDI-6 score—aOR, 1.03 (P=0.005)
A high degree of straining during defecation, considered a possible indicator of advanced pelvic floor dysfunction, was defined as straining in more than 75% of bowel movements. Constipated women who endorsed this degree of straining were more likely than others to report nocturia and a sensation of incomplete bladder emptying (P<0.05 for both comparisons).
Opportunities to Improve Care
Clinicians caring for women with chronic idiopathic constipation should inquire about any coexisting urogenital symptoms. This approach is particularly important because many medications commonly used to treat urinary incontinence, such as anticholinergic drugs, are constipating.
To provide comprehensive care, pelvic floor specialists should assess patients for the presence and severity of both urogenital and bowel symptoms.
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