Effects of vaginal hysterectomy on anorectal sensorimotor functions - a prospective study

• Published in: Neurogastroenterology and motility 2012-03, Vol.24 (3), p.235-241
• Main Authors: Bharucha, A. E., Klingele, C. J., Seide, B. M., Gebhart, J. B., Zinsmeister, A. R.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anal Canal - physiology; Anal Canal - physiopathology; anal pressures; Anorectal; anorectal functions; Benign; compliance; Defecation - physiology; Fecal Incontinence - physiopathology; Female; Humans; Hysterectomy; Hysterectomy, Vaginal - adverse effects; Intestine; Manometry; Middle Aged; Pelvic Floor Disorders - surgery; Perception; Pressure; Prospective Studies; Radicals; rectal sensation; Rectum; Rectum - physiology; Rectum - physiopathology; reproducibility; Sensation - physiology; sensorimotor system; Sensory Thresholds - physiology; Urinary bladder; Vagina
• ISSN: 1350-1925; 1365-2982
• DOI: 10.1111/j.1365-2982.2011.01825.x

Background  While bowel and bladder dysfunction are recognized consequences of a radical hysterectomy, the effects of a simple hysterectomy on anorectal sensorimotor functions, particularly rectal sensation, vary among studies and the effects on rectal compliance remain unknown. Our aims were to prospectively evaluate anorectal sensorimotor functions before and after a hysterectomy. Methods  Anal pressures, rectal compliance, capacity, sensation, and bowel symptoms were assessed before, at 2 months, and at 1 year after a simple vaginal hysterectomy for benign indications in 19 patients. Rectal staircase (0–44 mmHg, 4‐mmHg steps), ramp (0–200 mL at 50, 200 and 600 mL min−1) and phasic distentions (8, 16, and 24 mmHg above operating pressure) were performed. Key Results  Anal resting (63 ± 4 before, 56 ± 4 mmHg after) and squeeze pressures (124 ± 12 before, 124 ± 12 mmHg after), rectal compliance and capacity (285 ± 12 before, 290 ± 11 mL 1 year after), and perception of phasic distentions were not different before vs after a hysterectomy. Sensory thresholds for first sensation and the desire to defecate were also not different, but pressure and volume thresholds for urgency were somewhat greater (Hazard ratio = 0.7, 95% CI [0.5, 1.0]) 1 year after (vs before) a hysterectomy. Rectal pressures were higher (P