Association Between Age and Bowel Symptoms After Pelvic Organ Prolapse Surgery

Objectives: There is limited information on the effect of prolapse surgery on bowel symptoms. We aimed to evaluate whether increasing age is associated with change in bowel symptoms 3-6 months after reconstructive pelvic organ prolapse (POP) surgery.

Methods: This was a pooled analysis of individual participant data from four previously conducted randomized clinical trials (RCTs) of women undergoing POP surgery. The four RCTs were conducted by the Pelvic Floor Disorders Network (CARE, OPUS, OPTIMAL, and SUPeR). RCT participants were included if they had baseline pre-operative bowel symptoms, defined as Colorectal Anal Distress Inventory-8 (CRADI-8) score ≥5 based on CRADI-8 minimum clinically important difference. Participants who underwent obliterative POP surgery were excluded. The primary outcome was median change in CRADI-8 scores from baseline at 3-6 months post-operatively across four participant age groups, ≤49, 50-59, 60-69, and ≥70 years. Secondary analyses by age group included proportion of participants with at least a 5-point improvement in total CRADI-8 score, persistence of composite bowel symptoms (total CRADI-8 score >0) and persistence of bowel symptom subtypes (obstructive, incontinence, or irritative CRADI subscale score >0) post-operatively. Multivariate logistic regression models estimated odds of persistent postoperative bowel symptoms controlling for baseline CRADI-8 score and original participant RCT. P < .05 was considered significant.

Results: Of the 1,138 original trial participants, 707 participants were included. The median baseline CRADI-8 score, median change in total CRADI-8 score at 3-6 months post-operatively, and proportion with ≥5 point improvement in total CRADI-8 score at 3-6 months post-operatively were not significantly different across age groups (Table 1). Compared with ≤49 years age group, at 3-6 months post-operatively, older age groups (50-59, 60-69, and ≥ 70) had increased odds of persistent composite bowel symptoms (total CRADI-8 score >0) and increased odds of persistent anal incontinence symptoms (Table 2). Baseline CRADI-8 score was associated with increased odds of persistent bowel symptoms post-operatively (OR 1.02, 95% CI [1.01, 1.03]).

Conclusions: Older women are more likely to have persistent anal incontinence symptoms after reconstructive POP surgery compared to younger women. Age is not associated with persistence of obstructive or irritative bowel symptoms after POP surgery. Worse preoperative bowel symptoms are associated with increased odds of persistent bowel symptoms.