Prevalence of voiding and defecatory dysfunction in postmenopausal women with pelvic organ prolapse: a prospective observational study

Nanthini Saravanan, Emily Divya Ebenezer, Vaibhav Londhe, Lilly Varghese, Aruna N. Kekre, Vishalakshi Jeyaseelan, Nitin Kekre


Background: Primary objective of this work was to study the prevalence of voiding and defecatory dysfunction in women with pelvic organ prolapse and correlate the stage and compartment of prolapse with voiding and defecatory dysfunction. The secondary objective was to correlate stage of prolapse with flow rate and post void residue and to study the voiding dysfunction in pelvic organ prolapse.

Methods: A prospective observational cohort study in 120 post-menopausal women scheduled for vaginal hysterectomy pelvic floor repair. Short form of pelvic floor distress inventory (PFDI-20) and International prostate symptom questionnaire I-PSS score for Lower urinary tract symptoms (LUTS)was employed.

Results: The prevalence of voiding dysfunction in this study was 78% and defecatory dysfunction was 77%. Higher stage of prolapse had significant correlation with voiding dysfunction. (P value was 0.028). Women with posterior compartment defect had more voiding dysfunction with the significant P value (p value was 0.04). Pre-operative voiding dysfunction resolved post operatively in 86%, the p<0.000 which was highly significant.

Conclusions: Women with pelvic organ prolapse had high prevalence of voiding and defecatory dysfunction. Stages of prolapse have positive correlation with voiding dysfunction. Pre-operative voiding dysfunction resolved after vaginal hysterectomy and pelvic floor repair.


Defecatory dysfunction, Pelvic organ prolapse, Post-menopausal, Post void residue, Uroflowmetry, Voiding dysfunction

Full Text:



Lowder JL, Ghetti C, Nikolajski C, Oliphant SS, Zyczynski HM. Body image perceptions in women with pelvic organ prolapse: a qualitative study. Am J Obstet Gynecol. 2011;204:441.e1-441.e5.

Jackson S, Weber A, Hull T, Mitchinson A, Walters M. Fecal incontinence in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol. 1997;89:423–7.

Chae JY, Park GY, Kim JH, Kim HJ, Bae JH, Lee JG, et al. Points Aa and Ba are factors associated with preoperative voiding dysfunction in patients with cystocele. Eur J Obstet Gynecol Reprod Biol. 2014;174:146–9.

Olsen A, Smith V, Bergstrom J, Colling J, Clark A. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997;89:501–6.

Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the women’s health initiative: Gravity and gravidity. Am J Obstet Gynecol. 2002;186:1160–6.

Romanzi LJ, Chaikin DC, Blaivas JG. The effect of genital prolapse on voiding. J Urol. 1999;161:581–6.

Saks EK, Harvie HS, Asfaw TS, Arya LA. Clinical significance of obstructive defecatory symptoms in women with pelvic organ prolapse. Int J Gynecol Obstet. 2010;111:237–40.

Pott-Grinstein E, Newcomer JR. Gynecologists’ patterns of prescribing pessaries. J Reprod Med. 2001;46:205–8.

Obinata D, Yamaguchi K, Ito A, Murata Y, Ashikari D, Igarashi T, et al. Lower urinary tract symptoms in female patients with pelvic organ prolapse: Efficacy of pelvic floor reconstruction: LUTS in POP patients and TVM±TOT. Int J Urol. 2014;21:301–7.

Okamura K, Nojiri Y, Osuga Y, Tange C. Psychometric Analysis of International Prostate Symptom Score for Female Lower Urinary Tract Symptoms. Urology. 2009;73:1199–202.

Scarpero HM, Fiske J, Xue X, Nitti VW. American Urological Association Symptom Index for lower urinary tract symptoms in women: correlation with degree of bother and impact on quality of life. Urology. 2003;61:1118–22.

Nguyen JK, Bhatia NN. Resolution of motor urge incontinence after surgical repair of pelvic organ prolapse. J Urol. 2001;166:2263–6.

Collins SA, O’Sullivan DM, Lasala CA. Correlation of POP-Q posterior compartment measures with defecatory dysfunction. Int Urogynecology J 2012;23:743-7.