Association of compartment defects in pelvic floor dysfunction

OBJECTIVE. Dynamic cystoproctography was used to determine the frequency of associated urinary, genital, and anorectal abnormalities in women with pel vic floor dysfunction. SUBJECTS AND METHODS. We categorized, by pelvic floor compartments, the sym ptoms at presentation of 100 consecutive female patients who had been refer red for dynamic cystoproctography. We then analyzed the compartment defects seen on dynamic cystoproctography relative to those detected on clinical p resentation. RESULTS. Of the 20 patients with symptoms of anterior compartment (urinary) defect, dynamic cystoproctography revealed that 45% had vaginal vault prol apse of more than 50% and that 90% had rectoceles. Of the 45 patients with symptoms of middle compartment (genital) defect, dynamic cystoproctography revealed that 91% had cystoceles, 56% had a hypermobile bladder neck, 82% h ad rectoceles, 58% had enteroceles, 11% had sigmoidoceles, 20% had rectoana l intussusception, and 16% had anal incontinence. Of the 17 patients with s ymptoms of posterior compartment (anorectal) defect, dynamic cystoproctogra phy showed that 71% had cystoceles, 65% had a hypermobile bladder neck, and 35% had vaginal vault prolapse of more than 50%. Of the 18 patients with s ymptoms of defects from a combination of compartments, dynamic cystoproctog raphy revealed that 89% had cystoceles, 56% had a hypermobile bladder neck, 39% had vaginal vault prolapse exceeding 50%, 100% had rectoceles (of whic h 45% were large), 6% had enteroceles, 6% had sigmoidoceles, 22% had rectoa nal intussusception, and 6% had anal incontinence. CONCLUSION. Although patients may present with symptoms that involve only o ne compartment, a multicompartment prolapse is usually revealed on dynamic cystoproctography. Of the patients with pelvic floor dysfunction, 95% had a bnormalities in all three compartments.