Pelvic Organ Support Study (POSST) and bowel symptoms: Straining at stool is associated with perineal and anterior vaginal descent in a general gynecologic population

Margie A. Kahn, Carmen Radecki Breitkopf, Michael T. Valley, Patrick J. Woodman, Amy L. O'Boyle, Deirdre I. Bland, Joesph I. Schaffer, James J. Grady, Steven E. Swift

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


Objective: The purpose of this study was to evaluate the association of constipation symptoms and anal incontinence with vaginal wall and pelvic organ descent in a general gynecologic population. Study design: In this multicenter, cross-sectional study, 1004 women attending routine gynecologic healthcare underwent pelvic organ prolapse quantification (POPQ) measurements, and were surveyed regarding anal incontinence, digitation, <2 bowel movements (BMs)/week, and O25% frequency of: straining, hard/lumpy stools, and incomplete emptying. Constipation scores reflected the sum of positive responses. Associations between POPQ measurements (Ba, C, Bp, ghCpb), constipation scores, and anal incontinence were evaluated using multivariable regression. Results: Of 119 women with Bp ≥-1.00, 47% reported no constipation symptoms. Hard/lumpy stools (26%), incomplete emptying (24%), and straining (24%) were more prevalent; fewer women reported <2 BMs/week (15%) or digitation (7%). Constipation scores were weakly correlated with Bp, gh+pb (both r < .1, P < .02). Women reporting ≥2 symptoms had greater gh+pb measurements than women reporting 0 or 1 symptom (P =.03). Women with anal incontinence had greater ghCpb and gh values than women without anal incontinence (P < .01). POPQ measurements were regressed separately onto (1) total constipation scores, (2) dichotomized scores, and (3) individual symptoms, with BMI, age, number of vaginal deliveries (NVD), weight of largest vaginal delivery (WLVD), race, hysterectomy, study site, and income included as covariates. Total constipation scores and dichotomized scores were nonsignificant in all models. With regard to individual symptoms, straining at stool was significant in the models for Ba and ghCpb, with greater Ba and gh+pb measurements among strainers relative to nonstrainers. Conclusion: Most associations between bowel symptoms and vaginal or pelvic organ descent were weak. After controlling for important covariates, straining at stool remained associated with anterior vaginal wall and perineal descent.

Original languageEnglish (US)
Pages (from-to)1516-1522
Number of pages7
JournalAmerican journal of obstetrics and gynecology
Issue number5 SPEC. ISS.
StatePublished - May 2005


  • Anal incontinence
  • Constipation
  • Pelvic organ prolapse
  • Perineal descent
  • Straining

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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