The purpose of this study was 1) to determine the prevalence of functional bowel and anorectal disorders as defined by the Rome Ⅱ criteria in patients with advanced pelvic organ prolapse (POP) and urinary incontinenc...The purpose of this study was 1) to determine the prevalence of functional bowel and anorectal disorders as defined by the Rome Ⅱ criteria in patients with advanced pelvic organ prolapse (POP) and urinary incontinence (UI), and (2) to determine if the extent of prolapse on gynecologic examination is related to the subtypes of constipation or any functional anorectal pain disorder. Study design: Three hundred and two consecutive female subjects presenting to a tertiary urogynecology clinic were enrolled. Demographic, general medical, and physical examination information, including POPQ measurements and a standardized sacral neurologic evaluation, were collected. The prevalence of functional disorders of the bowel, rectum, and anus as defined by the Rome Ⅱ criteria were collected using the Rome Ⅱ Modular questionnaire. Relationships of functional disorders to various components of the vaginal examination were reviewed. Results: Thirty six percent (108/302) met the criteria for constipation, including the following subtypes: 19% outlet constipation, 5% functional constipation, 5% constipation predominant irritable bowel syndrome (IBS), and 7% IBS outlet. Nineteen percent (56/302) of subjects had IBS or 1 of its subtypes. Functional diarrhea was seen in 6% (17/302), fecal incontinence in 19% (58/302), and anorectal pain disorders in 25% (77/302). After controlling for age, parity, diabetes, constipating medications, and previous pelvic surgery, there were no differences in the prevalence of constipation or any of its subtypes between patients with UI and those with stage 3 or 4 POP. Fecal incontinence was independently associated with UI (adjusted odds ratio[OR] 6.3; 95% CI 2.6- 19.1), but not advanced POP. Neither overall stage of POP nor stage of posterior vaginal prolapse was significantly associated with any of the functional bowel disorders, including constipation and its subtypes. Perineal body measurement was significantly longer in patients with outlet type constipation (mean 3.5 ± 0.6 cm vs 3.1 ± 0.9 cm, P < .01) and in those with proctalgia fugax (mean 3.4 ± 1.0 vs 3.1 ± 0.8, P < .05). Conclusion: There is a high prevalence of constipation and anorectal pain disorders in women with urinary incontinence and pelvic organ prolapse. However, patients with stage 3 or 4 pelvic organ prolapse have similar rates of constipation compared with those with urinary incontinence. Constipation and its subtypes are not related to the stage of pelvic organ prolapse. It appears that either constipation is not a significant contributor to prolapse, or constipation contributes equally to the development of both urinary incontinence and pelvic organ prolapse.展开更多
Objective: To evaluate the association between ectopic pregnancy (EP) and clinical and historical factors among women presenting with pain and/or bleeding in early pregnancy. Design: Nested case-control study. Setting...Objective: To evaluate the association between ectopic pregnancy (EP) and clinical and historical factors among women presenting with pain and/or bleeding in early pregnancy. Design: Nested case-control study. Setting: University medical center. Patient(s): Women with symptomatic early pregnancies of unknown location presenting for care between January 1, 1990 and July 31, 1999. Intervention(s): None. Main Outcome Measure(s): Clinical and historical risk factors were compared between women with EP and women with ongoing intrauterine pregnancies or spontaneous abortions. Result(s): The following factors were associated with increased risk of EP: prior EP (odds ratio, 2.98 [95% confidence interval, 1.88- 4.73] for one prior EP and 16.04 [5.39- 47.72] for 2 or more), pelvic inflammatory disease history (1.5 [1.11- 2.05]), pain at presentation (1.42 [1.06- 1.92]),vaginal bleeding at presentation (1.42 [1.04- 1.93]), and hCG of 501- 2,000 mIU/mL (1.73 [1.24- 2.42]). Age younger than 25 years (0.59 [0.41- 0.85]) and a history of abortion were protective from EP (0.58 [0.38- 0.90]). Prior nontubal pelvic surgery, past intrauterine device use, prior cesarean section, and current cervical infection demonstrated no association with EP. Conclusion(s): Evaluation of women with a symptomatic early pregnancy confirms and refutes some of the classical risk factors for EP. Prior EP is a strong risk factor, whereas pelvic inflammatory disease has an unexpected weak association. Previous abortion was found to have a negative association, whereas nontubal surgery, cesarean section, and a history of or concomitant cervical infection have no association. Knowledge of historical and clinical factors associated with EP may aid in early diagnosis.展开更多
文摘The purpose of this study was 1) to determine the prevalence of functional bowel and anorectal disorders as defined by the Rome Ⅱ criteria in patients with advanced pelvic organ prolapse (POP) and urinary incontinence (UI), and (2) to determine if the extent of prolapse on gynecologic examination is related to the subtypes of constipation or any functional anorectal pain disorder. Study design: Three hundred and two consecutive female subjects presenting to a tertiary urogynecology clinic were enrolled. Demographic, general medical, and physical examination information, including POPQ measurements and a standardized sacral neurologic evaluation, were collected. The prevalence of functional disorders of the bowel, rectum, and anus as defined by the Rome Ⅱ criteria were collected using the Rome Ⅱ Modular questionnaire. Relationships of functional disorders to various components of the vaginal examination were reviewed. Results: Thirty six percent (108/302) met the criteria for constipation, including the following subtypes: 19% outlet constipation, 5% functional constipation, 5% constipation predominant irritable bowel syndrome (IBS), and 7% IBS outlet. Nineteen percent (56/302) of subjects had IBS or 1 of its subtypes. Functional diarrhea was seen in 6% (17/302), fecal incontinence in 19% (58/302), and anorectal pain disorders in 25% (77/302). After controlling for age, parity, diabetes, constipating medications, and previous pelvic surgery, there were no differences in the prevalence of constipation or any of its subtypes between patients with UI and those with stage 3 or 4 POP. Fecal incontinence was independently associated with UI (adjusted odds ratio[OR] 6.3; 95% CI 2.6- 19.1), but not advanced POP. Neither overall stage of POP nor stage of posterior vaginal prolapse was significantly associated with any of the functional bowel disorders, including constipation and its subtypes. Perineal body measurement was significantly longer in patients with outlet type constipation (mean 3.5 ± 0.6 cm vs 3.1 ± 0.9 cm, P < .01) and in those with proctalgia fugax (mean 3.4 ± 1.0 vs 3.1 ± 0.8, P < .05). Conclusion: There is a high prevalence of constipation and anorectal pain disorders in women with urinary incontinence and pelvic organ prolapse. However, patients with stage 3 or 4 pelvic organ prolapse have similar rates of constipation compared with those with urinary incontinence. Constipation and its subtypes are not related to the stage of pelvic organ prolapse. It appears that either constipation is not a significant contributor to prolapse, or constipation contributes equally to the development of both urinary incontinence and pelvic organ prolapse.
文摘Objective: To evaluate the association between ectopic pregnancy (EP) and clinical and historical factors among women presenting with pain and/or bleeding in early pregnancy. Design: Nested case-control study. Setting: University medical center. Patient(s): Women with symptomatic early pregnancies of unknown location presenting for care between January 1, 1990 and July 31, 1999. Intervention(s): None. Main Outcome Measure(s): Clinical and historical risk factors were compared between women with EP and women with ongoing intrauterine pregnancies or spontaneous abortions. Result(s): The following factors were associated with increased risk of EP: prior EP (odds ratio, 2.98 [95% confidence interval, 1.88- 4.73] for one prior EP and 16.04 [5.39- 47.72] for 2 or more), pelvic inflammatory disease history (1.5 [1.11- 2.05]), pain at presentation (1.42 [1.06- 1.92]),vaginal bleeding at presentation (1.42 [1.04- 1.93]), and hCG of 501- 2,000 mIU/mL (1.73 [1.24- 2.42]). Age younger than 25 years (0.59 [0.41- 0.85]) and a history of abortion were protective from EP (0.58 [0.38- 0.90]). Prior nontubal pelvic surgery, past intrauterine device use, prior cesarean section, and current cervical infection demonstrated no association with EP. Conclusion(s): Evaluation of women with a symptomatic early pregnancy confirms and refutes some of the classical risk factors for EP. Prior EP is a strong risk factor, whereas pelvic inflammatory disease has an unexpected weak association. Previous abortion was found to have a negative association, whereas nontubal surgery, cesarean section, and a history of or concomitant cervical infection have no association. Knowledge of historical and clinical factors associated with EP may aid in early diagnosis.
