Obstructive defecation in middle-aged women
Obstructive defecation in middle-aged women
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DOI：
10.1007/s10620-008-0226-x
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发表时间：
2008-10-01
影响因子：
3.1
通讯作者：
Thom, David H.
中科院分区：
文献类型：
--
作者：
Varma, Madhulika G.;Hart, Stacey L.;Thom, David H.
排便阻塞是便秘的一个重要因素，经常在中年妇女中报告，但很少有基于人群的研究确定了这一群体的患病率。我们分析了来自Kaiser的Incentive研究的生殖风险数据，这是一项基于人群的队列研究，研究对象为40-69岁的不同种族女性，以描述梗阻性排便的患病率并确定相关的风险因素。在Kaiser进行的生殖风险研究是在Kaiser医疗系统中随机选择的2，109名女性的队列。通过自我报告确定的梗阻性排便定义为排便困难、硬便、用力超过15分钟或排便不完全，至少每周发生一次。对年龄、种族、收入、教育、饮酒、健康状况、产次、盆腔器官脱垂、尿失禁、用药次数、子宫切除术、盆腔器官脱垂手术、结肠切除术、肠易激综合征和体重指数与梗阻性排便的单变量和多变量相关性进行评估。采用多因素logistic回归分析确定相关因素与梗阻性排便主要结局之间的独立相关性。12.3%的妇女报告至少每周发生一次排便阻塞。显著的独立危险因素包括肠易激综合征[比值比1.78，（95%置信区间1.21-2.60）]，阴道或腹腔镜子宫切除术[2.01（1.15-3.54）]、失业[2.33（1.39-3.92）]，使用三种或三种以上药物[1.81（1.36-2.42）]、症状性盆腔器官脱垂[2.34（1.47-3.71）]、尿失禁手术[2.52（1.29-4.90）]和其他盆腔手术[1.35（1.03-1.78）]。我们的结论是，排便障碍在中年妇女中很常见，尤其是那些有骨盆底疾病治疗史的妇女。曾接受腹腔镜/阴道直肠切除术或盆腔器官脱垂或尿失禁手术的女性每周排便阻塞的风险增加近两倍。除就业状况外，人口因素并不重要，这表明排便障碍虽然普遍存在，但并不影响任何特定的妇女群体。
Obstructive defecation, a significant contributor to constipation, is frequently reported in middle-aged women, yet few population-based studies have established prevalence in this group. We analyzed data from the Reproductive Risks for Incontinence Study at Kaiser, a population-based cohort of racially diverse women, 40-69 years old, to describe the prevalence of obstructive defecation and identify associated risk factors. The Reproductive Risks for Incontinence Study at Kaiser is a randomly selected cohort of 2,109 women in the Kaiser Medical System. Obstructive defecation, determined by self-report, was defined as difficulty in passing stool, hard stool, straining for more than 15 min, or incomplete evacuation, occurring at least weekly. Age, race, income, education, drinking, health status, parity, pelvic organ prolapse, urinary incontinence, number of medications, hysterectomy, surgery for pelvic organ prolapse, colectomy, irritable bowel syndrome, and body mass index were assessed for both their univariate and multivariate association with obstructive defecation. Multivariate logistic regression was used to determine the independent association between associated factors and the primary outcome of obstructive defecation. Obstructive defecation that occurred at least weekly was reported by 12.3% of women. Significant independent risk factors included irritable bowel syndrome [odds ratio 1.78, (95% confidence interval 1.21-2.60)], vaginal or laparoscopic hysterectomy [2.01 (1.15-3.54)], unemployment [2.33 (1.39-3.92)], using three or more medications [1.81 (1.36-2.42)], symptomatic pelvic organ prolapse [2.34 (1.47-3.71)], urinary incontinence surgery [2.52 (1.29-4.90)], and other pelvic surgery [1.35 (1.03-1.78)]. We concluded that obstructive defecation is common in middle-aged women, especially those with a history of treatment for pelvic floor conditions. Women who had undergone laparoscopic/vaginal hysterectomies or surgery for pelvic organ prolapse or urinary incontinence had a nearly two times greater risk of weekly obstructive defecation. Demographic factors, with the exception of employment status, were not significant, indicating that obstructive defecation, although widespread, does not affect any particular group of women.