# Characteristics and evolution of pelvic floor structures in female patients aged over 40 years with constipation—a retrospective cohort study

## TL;DR

This study examines how pelvic floor structures change in women over 40 with constipation, finding that rectocele and uterine descent are linked to constipation and that these structures worsen over time.

## Contribution

The study identifies specific pelvic floor structural changes associated with constipation and tracks their progression over two years in affected women.

## Key findings

- Rectocele and uterine descent at maximal Valsalva maneuver are positively associated with constipation.
- Pelvic floor structures in constipated women show progressive descent of the bladder, uterus, and rectum over two years.
- Perineal hypermobility and enlarged levator ani hiatus area are observed in constipated patients.

## Abstract

Pelvic floor dysfunction (PFD) is a common cause of chronic constipation which can reciprocally exacerbate pelvic floor burden. However, the characteristics and evolution of pelvic floor structures in patients with constipation remain unclear. This study investigates the characteristics and evolution of pelvic floor structures in constipated women aged over 40 years.

Clinical data were collected from female patients undergoing pelvic floor ultrasound at the Third Affiliated Hospital of Sun Yat-sen University from December 2020 to August 2023. Propensity score matching (PSM) minimized confounders between the constipation (n = 247) and non-constipation (n = 898) groups. We analyzed intergroup differences in ultrasound data and changes in pelvic floor structure over time among constipated patients.

Significant intergroup differences emerged in uterine prolapse (P = 0.042), rectocele (P = 0.022), levator ani hiatus dilation (P=0.013), hiatus area (P < 0.01), the position of the uterus (P < 0.01), and rectal ampulla (P = 0.017) at maximal Valsalva maneuver (VM). Multivariate analysis identified rectocele (P = 0.023) and uterine descent at maximal VM (P = 0.026) as positively associated with constipation occurrence. Multiple ultrasonographic evaluations over two years revealed stable pelvic floor anatomy in non-constipated individuals but identified alterations in 78 constipated patients, including increased vesicocele (P = 0.039), uterine prolapse (P = 0.019), perineal hypermobility (P = 0.015), lower bladder (P < 0.001) and rectal ampulla (P < 0.01) positions at maximal VM, greater bladder descent (P < 0.01), and enlarged hiatus area (P < 0.01).

This study demonstrates that rectocele and uterine descent at maximal VM exhibit positive associations with constipation. Over time, further descent of the bladder, uterus, and rectum occurs in female patients with constipation, along with an increase in perineal mobility and levator ani hiatus area.