Does a history of rectal (rectal) and uterine prolapse increase the risk of constipation?

From the Guidelines

Yes, a history of rectal and uterine prolapse does increase the risk of constipation. These pelvic floor disorders can disrupt normal bowel function by altering the anatomical structures needed for proper defecation. When the rectum prolapses (drops down), it can create a physical obstruction that makes it difficult to pass stool completely. Similarly, uterine prolapse can press against the rectum, narrowing the passage for stool and causing mechanical obstruction. These conditions often occur together as part of pelvic floor dysfunction, where weakened muscles and connective tissues fail to provide adequate support, as noted in the 2022 study on pelvic floor dysfunction in females 1.

Key Points to Consider

• The relationship between prolapse and constipation is bidirectional, with chronic constipation potentially worsening existing prolapses and vice versa.
• Management of constipation in patients with a history of rectal and uterine prolapse typically involves a multifaceted approach, including dietary changes (such as increased fiber intake), adequate hydration, pelvic floor physical therapy, and possibly the use of stool softeners.
• Surgical intervention may be necessary in severe cases to correct the prolapse and alleviate constipation, with the choice of surgical approach (abdominal vs. perineal) depending on the patient's specific condition and overall health, as discussed in the 2017 review on surgical interventions for fecal incontinence and defecatory disorders 1.

Treatment Considerations

• Increased fiber intake of 25-30g daily can help soften stool and make it easier to pass.
• Adequate hydration with at least 2 liters of water daily is essential for preventing constipation.
• Pelvic floor physical therapy can help strengthen the muscles that support the pelvic organs and improve bowel function.
• Stool softeners like docusate sodium (100mg twice daily) may be prescribed to facilitate easier passage of stool.

Surgical Options

• Abdominal approach (e.g., resection, rectopexy, or both) may be considered for symptomatic grade 3–4 prolapse.
• Perineal approach is often used in clinical practice, especially for elderly patients or those with significant medical comorbidities, despite a higher recurrence rate.
• The decision to divide or preserve the lateral ligaments during surgery should be made with consideration of the potential for postoperative constipation, as division may reduce recurrent prolapse but increase constipation risk, as noted in the study 1.

From the Research

Relationship Between Rectal and Uterine Prolapse and Constipation Risk

• The relationship between a history of rectal and uterine prolapse and the risk of constipation is complex and not fully understood 2, 3, 4, 5, 6.
• Studies have shown that pelvic organ prolapse (POP) can have a significant impact on a patient's quality of life, including symptoms of pelvic pressure, vaginal bulge, urinary and bowel dysfunction, or sexual dysfunction 2.
• A study found that 36% of patients with advanced pelvic organ prolapse met the criteria for constipation, including outlet constipation, functional constipation, and constipation-predominant irritable bowel syndrome (IBS) 6.
• However, the study also found that the prevalence of constipation and its subtypes was not related to the stage of pelvic organ prolapse, suggesting that constipation may not be a significant contributor to prolapse 6.
• Another study found that a history of cervical insufficiency was associated with an increased risk of pelvic organ prolapse and stress urinary incontinence, but did not specifically examine the relationship between rectal and uterine prolapse and constipation risk 5.
• A review of the current treatment of pelvic organ prolapse correlated with chronic pelvic pain, bladder, and bowel dysfunction found that repair of specific pelvic ligaments can cure or substantially improve symptoms of abnormal emptying of the bladder, urgency, pelvic pain, and anorectal dysfunction in 42-94% of patients 4.

Key Findings

• High prevalence of constipation and anorectal pain disorders in women with urinary incontinence and pelvic organ prolapse 6.
• No significant association between the stage of pelvic organ prolapse and the prevalence of constipation or its subtypes 6.
• History of cervical insufficiency associated with increased risk of pelvic organ prolapse and stress urinary incontinence 5.
• Repair of specific pelvic ligaments can improve symptoms of pelvic organ prolapse and associated bowel dysfunction 4.