Bowel symptoms and quality of life in women with pelvic organ prolapse

OBJECTIVES: Many women with pelvic organ prolapse report bowel-related symptoms. The relationship between bowel symptoms, prolapse, and quality of life has not been clearly delineated. The primary objective of this study was to determine if leading edge of pelvic organ prolapse is associated with bowel symptoms, distress, and quality of life. METHODS: This was an IRB-approved cross-sectional study. Bowel symptom presence and bother was assessed using the Colorectal-Anal Distress Inventory (CRADI). Bowel symptom impact on quality of life was measured with the Colorectal-Anal Impact Questionnaire (CRAIQ). Stage of prolapse, predominant compartment of prolapse, and leading edge of prolapse were determined using the Pelvic Organ Prolapse Quantification examination. Multivariable linear regression modeling was used to estimate the association between bowel symptoms and prolapse, using leading edge of prolapse as the dependent variable. Polytomous regression was used to estimate the association of factors which increased the CRADI and CRAIQ total scores. RESULTS: A total of 336 women with ± stage I prolapse were enrolled. The study population had a mean age of 62 ± 13 years. Bowel symptoms (as measured by the CRADI) and bowel-related quality of life (as measured by the CRAIQ) scores did not change as prolapse progressed by prolapse stage. Women with posterior-predominant prolapse reported significantly higher CRAIQ total and subscale scores (P < 0.05). Multivariable linear regression showed that an increase in the leading edge of prolapse was associated with an increase in CRADI, after adjusting for age. Among women with posterior-predominant prolapse, only age (β = 0.36, P = 0.01) and history of a prior incontinence procedure (β = -0.24, P = 0.005) were significantly associated with leading edge of prolapse. Polytomous logistic regression demonstrated that prior hysterectomy (RR = 3.6 to 6.4; P < 0.008) was significantly associated with higher total CRADI and CRAIQ scores. CONCLUSIONS: Bothersome bowel symptoms that negatively impact a woman's quality of life may occur with any amount of prolapse. After adjusting for age, more severe symptoms appear to be related to the leading edge of prolapse. Prior hysterectomy appears to have the largest influence on bowel symptom scores and quality of life scores.