Prevalência das disfunções do assoalho pélvico utilizando ultrassom 3D dinâmico em mulheres com sintomas de evacuação obstruída e sua relação com idade, paridade e parto vaginal

Abstract

Considerable controversy remains regarding the prevalence of pelvic floor disorders and their associated risk factors, largely due to biases related to the study populations and methodologies used. Few studies have employed dynamic three-dimensional imaging to identify pelvic floor dysfunctions and correlate them with factors such as mode of delivery, parity, or patient age. Therefore, this study aimed to determine the prevalence of pelvic floor disorders in female patients with obstructed defecation and to assess their association with age, mode of delivery, and parity using dynamic three-dimensional anorectal ultrasound (3D-US). This cohort study was conducted in the colorectal surgery unit of a tertiary hospital. Female patients presenting with symptoms of obstructed defecation who, despite increased dietary fiber intake, maintained a Cleveland Clinic Florida Constipation Score greater than 6 underwent echodefecography (EDF) to evaluate the presence of posterior pelvic floor dysfunction. The findings were then correlated with history of vaginal delivery, parity, and age. A total of 889 women were included: 552 (62%) had a history of vaginal delivery, and 337 (38%) were nulliparous. The mean age was significantly higher among women with a history of vaginal delivery. Previous anorectal surgeries were more frequent among nulliparous women (p = 0.043). The prevalence of posterior pelvic floor disorders—including rectocele, intussusception, enterocele/sigmoidocele, and anismus—was similar between the two groups and was not associated with the number of vaginal deliveries or with age. However, the prevalence of sphincter defects was higher in the vaginal delivery group and was positively associated with parity. In conclusion, the prevalence of obstructed defecation disorders such as rectocele, intussusception, and enterocele/sigmoidocele, as assessed by EDF, was not associated with vaginal delivery, number of deliveries, or age. Nevertheless, symptoms of fecal incontinence and obstructed evacuation were more prevalent among older women, regardless of prior vaginal deliveries. No association was found between age and the prevalence of sphincter defects in nulliparous women.