eP629 - Phenotype and Clinical Characteristics of Women with Rectal Prolapse That Presents Only During Defecation

Purpose/Background: While some patients report full thickness rectal prolapse (FTRP) exclusively during defecation, others may experience it during routine activities or even persistently. We hypothesized that patients with rectal prolapse (RP) only during defecation have distinct clinical characteristics and aimed to identify the phenotypes of patients with RP based on the RP occurrence.Methods/Interventions: We conducted a retrospective analysis of a prospectively maintained IRB-approved registry of patients undergoing evaluation for RP at a multidisciplinary Pelvic Health Center from 2017 to present. We included female patients who have FTRP with defecation and compared them to women who had FTRP during other times (walking, exercise, and/or all the time). Differences between the 2 groups were evaluated by Fisher’s exact test for categorical variables and Wilcoxon test for continuous variables.Results/Outcomes: Of 378 patients in our registry, 297 patients met our inclusion criteria: 147 (49%) women reports RP with defecation only, and 150 (51%) women reports RP during other times – the latter among which 81 women experience RP during walking and/or exercise (54%) and 69 women experience RP all the time (46%). We found that women who have RP with defecation only are younger (median [IQR] age: 64 [48, 74] vs. 71.5 [63, 79]); they are also more primarily bothered by obstructive defecation syndrome (ODS) (18% vs 6%, p=0.001), less primarily bothered by mucus drainage (22% vs 37%, p=0.005) and pain (31% vs 46%, p=0.009). Baseline ODS score is higher in women who have RP with defecation only (median [IQR]: 9 [5, 13] vs. 7 [4, 10], p < 0.001), while Wexner score is higher in women who have RP during other times (median [IQR]: 12 [3, 16] vs. 15 [12, 18], p < 0.001). The proportions of patients primarily bothered by fecal incontinence (41% vs 52%, p=0.06), discomfort (29% vs 31%, p=0.62), and bleeding (14% vs 21%, p=0.17) are similar between the 2 groups. Women who have RP with defecation only are more likely to have symptoms longer than 6 months (86% vs 73%, p=0.006). Prior RP surgery was similar between groups (24% vs 25%). A significant portion of the patients in our cohort (213, 72%) underwent surgical treatments: 129 (61%) underwent rectopexy, while 84 (39%) underwent rectopexy combined with vaginal prolapse repair. Ventral mesh rectopexy (VMR) was the most commonly performed procedure in both groups. Similar proportions of patients underwent VMR with synthetic mesh (11% vs 5%) versus biologic graft (44% vs 40%). Significantly more women who have RP with defecation only underwent abdominal surgery (78% vs 60%, p=0.007) versus perineal surgery. Both groups have similar recurrence rate of FTRP (11% vs 14%) and time to recurrence (median [IQR] days: 200 (128, 537) vs. 173 (111, 440)).Conclusion/

Discussion: Our findings, from a cohort of women with RP, demonstrate distinct differences in the clinical presentation and symptom severity of patients who experience RP exclusively during defecation. Based on these findings it is conceivable that the pathophysiology of RP in patients with RP exclusively with defecation may be linked to dyssynergic defecation. Further research is warranted to investigate differences in anorectal pressure profiles among the various phenotypes of patients with RP based on the occurrence of symptoms.Table 1. Patient Characteristics*statistically significant at α = 0.05