Impact of a Defecation Posture Modification Device on Ease of Bowel Movements in Patients With Posterior Compartment Prolapse and Bowel Dysfunction

INTRODUCTION: Many patients with pelvic organ prolapse suffer from defecatory dysfunction. Studies have shown that the angle of defecation can impact the ease of bowel movements. Devices to improve this angle are a promising means to enhance function. However, we lack information regarding the effect of such devices in patients diagnosed with posterior compartment prolapse. OBJECTIVE: The aim of this study was to determine if a defecation posture modification device (DPMD) improves ease of bowel movements in patients diagnosed with posterior compartment prolapse and self-reported bowel dysfunction. METHODS: This was a prospective cohort study of women diagnosed with posterior compartment prolapse stage 2 or greater who endorsed bowel dysfunction during office evaluation. Following enrollment, they completed a baseline questionnaire consisting of a numeric 0–10 scale regarding strain with bowel movement, satisfaction, pain, and feeling of complete emptying. A Bristol Stool Form Scale and CRADI-8 were also collected. The participants were given a DPMD to use with every bowel movement for two weeks. Patients refrained from any other interventions, including pessary and surgery during that time period. Participants were contacted to complete the post-intervention questionnaire, which repeated the baseline questionnaire and queried regarding satisfaction and ease of use of the device. Our primary outcome was straining with bowel movements. A sample size of 50 was required for 80% power to detect a clinically meaningful difference. RESULTS: For this study, 50 women were enrolled. The majority of participants were Caucasian with a median age of 66 years. All women reported bowel dysfunction during the initial office visit, 54% suffering from constipation, 44% splinting with bowel movements, and 32% reporting fecal incontinence. The majority had stage 2 posterior compartment prolapse. Regarding our primary outcome, patients reported a high level of strain at baseline, 7 out of 10, which lowered significantly to 3 at follow-up (p<0.0001). Pain levels also declined from 3 to 1/10 (p<0.0001), whereas satisfaction improved from 2 to 6/10 after DPMD use (p<0.0001). The sensation of complete emptying was not improved. There was also significant reduction in CRADI-8 scores from 31 to 20 (p<0.001) over the study period. We found no change in stool consistency or frequency with most subjects reporting Bristol Stool Form Scale of <4, indicating firmer bowel movements. When asked about device use, 88% of patients used it “most” or “all of the time.” It was reportedly “easy” to use for 94% of patients, and median satisfaction with the device was 8/10. A majority (78%) reported plans to continue using the DPMD following the study. CONCLUSIONS: A DPMD significantly improved strain, pain, and satisfaction with bowel movements in women with posterior compartment prolapse and bowel dysfunction. Patients reported high rates of satisfaction, ease of use, and intention to continue device use beyond the study period. This supports the use of a DPMD as a novel adjunctive therapy for women with bowel dysfunction and posterior compartment prolapse.Table 1Table 2