Warren Alpert Medical School of Brown University Providence, RI, United States
Albert Manudhane, MD, Chung Sang Tse, MD, Amanda Pressman, MD Warren Alpert Medical School of Brown University, Providence, RI
Introduction: Approximately 23.7% of women experience pelvic floor dysfunction, with its prevalence increasing with age. Anorectal manometry (ARM) is often utilized to assess sphincter function and to evaluate for evidence of pelvic floor dyssynergia in patients with refractory constipation and fecal incontinence. We aimed to identify the patient characteristics and risk factors for pelvic floor dysfunction, including age, gender, medical comorbidities, and surgical history.
Methods: A retrospective review of all ARM studies of adults performed between January 2015 and January 2021 at a single institution was conducted. ARM results were reviewed for evidence of sphincter weakness (of the internal and/or external anal sphincter) or dyssynergia outlet dysfunction, paradoxical anal contraction, inadequate relaxation, or delayed balloon expulsion. Univariate and multivariate analysis were examined for risk factors of pelvic floor dysfunction.
Results: A total of 495 patients (94% female, median age 53 years) who underwent ARM were studied, of which 19% were diabetic and 69% had prior abdominal/pelvic surgeries. The majority (71.3%) underwent ARM for evaluation of constipation, while 21% were for fecal incontinence and 7% for both incontinence and constipation.
On multivariate analysis, males were 2.9 times (p< .0001) more likely to have dyssynergia than females. Individuals tested for fecal incontinence were 21-times more likely to have anal sphincter weakness, and those tested for constipation were 6-times more likely to have dyssynergia on multivariate analysis (p< .0001). Diabetes (90% vs 79% p=.02) and prior rectal or abdominal surgery (23% vs 16%, p=.05) were associated with an increased risk for pelvic floor dysfunction on univariate analysis, but these were not significant on multivariate analysis.
Discussion: While the vast majority of patients completing ARM were female, males referred for testing were 2.9 times more likely to have dyssynergia. This may signal under-diagnosis of pelvic floor dysfunction among men, which may be due to male patients’ reluctance to seek care for symptoms of constipation/fecal incontinence or providers’ under-referral of men for ARM. Fecal incontinence and constipation testing indications were highly correlated with ARM findings of anal sphincter weakness and pelvic floor dyssynergia, respectively.
Albert Manudhane indicated no relevant financial relationships.
Chung Sang Tse indicated no relevant financial relationships.
Amanda Pressman indicated no relevant financial relationships.
Albert Manudhane, MD, Chung Sang Tse, MD, Amanda Pressman, MD. P1442 - Risk Factors for Pelvic Floor Dysfunction and Testing Bias? A 6-Year Retrospective Review of Anorectal Manometry at a Single Institution, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.