Perception of rectal prolapse symptoms in patients with psychiatric disorders

Table 1 Demographics and clinical characteristics, n (%)

		NPD (n = 117)	PD (n = 83)	Total (n = 200)	P value
Age	mean ± SD	66.11 ± 14.64	58.04 ± 15.72	62.76 ± 15.58	< 0.0011
	Median (interquartile range)	69 (59, 76)	62 (45, 68)	66 (53.50, 74)
Race	White, non-Hispanic	97 (83)	68 (82)	165 (83)	0.1192
	Black/African American	0 (0)	2 (2)	2 (1)
	Hispanic	7 (6)	6 (7)	13 (7)
	Asian	8 (7)	1 (1)	9 (5)
	More than one	0 (0)	1 (1)	1 (1)
	Other	4 (3)	5 (6)	9 (5)
Body mass index	mean ± SD	24.89 ± 5.62	24.98 ± 6.37	24.93 ± 5.93	0.8141
	Median (interquartile range)	23.97 (21.17, 27.50)	23.45 (20.45, 28.29)	23.79 (20.72, 27.76)
Past history	Diabetes	9 (8)	5 (6)	14 (7)	0.7822
	Cardiopulmonary morbidity	57 (49)	42 (51)	99 (50)	0.8862
	Chronic steroid use	6 (5)	7 (8)	13 (7)	0.3922
	Chronic cough	4 (3)	5 (6)	9 (5)	0.4942
	Pelvic radiation	3 (3)	2 (2)	5 (3)	1.0002
	Eating disorder	2 (2)	10 (12)	12 (6)	0.0042
	Sexual trauma	11 (9)	15 (18)	26 (13)	0.0902
	Chronic narcotic use	14 (12)	17 (20)	31 (16)	0.1152
	Chronic constipation	42 (36)	43 (52)	85 (43)	0.0302
	Chronic diarrhea	17 (15)	22 (27)	39 (20)	0.0472
	History of hysterectomy	52 (44)	27 (33)	79 (40)	0.1072
Nulliparity		26 (22)	26 (31)	52 (26)	0.1902
Prior pelvic floor surgery	Cystocele	7 (6)	2 (2)	9 (5)	0.3102
	Rectocele	10 (9)	9 (11)	19 (10)	0.6302
	Vaginal apical suspension	3 (3)	1 (1)	4 (2)	0.6432
	Sacrocolpopexy	2 (2)	2 (2)	4 (2)	1.0002
	Urinary incontinence procedure	5 (4)	6 (7)	11 (6)	0.5312
	Sphincteroplasty	1 (1)	0 (0)	1 (1)	1.0002

¹Wilcoxon test.

²Fisher’s exact test.

NPD: No psychiatric disorders; PD: Psychiatric disorders.

Table 2 Primary bothersome symptoms, n (%)

Primary bothersome symptoms	NPD (n = 117)	PD (n = 83)	Total (n = 200)	P value1
Mucus discharge	33 (28)	23 (28)	56 (28)	1.0
Fecal incontinence	60 (51)	40 (48)	100 (50)	0.78
Obstructed defecation syndrome	13 (11)	14 (17)	27 (14)	0.3
Pain	39 (33)	29 (35)	68 (34)	0.9
Discomfort	68 (34)	22 (27)	48 (24)	0.5
Bleeding	14 (12)	17 (20)	31 (16)	0.1
Minimal symptoms	7 (6)	4 (5)	11 (6)	1.0

¹Fisher’s exact test.

NPD: No psychiatric disorders; PD: Psychiatric disorders.

Table 3 Clinical characteristics of rectal prolapse, n (%)

		NPD (n = 117)	PD (n = 38)	Total (n = 200)	P value1
Duration	0-6 months	22 (19)	9 (11)	31 (16)	0.2
	6 months to 1 years	23 (20)	10 (12)	33 (17)
	1-2 years	24 (21)	24 (29)	48 (24)
	3-5 years	19 (16)	19 (23)	38 (19)
Description of the prolapse	Prolapse with defecation	81 (69)	64 (77)	145 (73)	0.3
	Prolapse with exercise	14 (12)	16 (19)	30 (15)	0.2
	Prolapse with walking	30 (26)	16 (19)	46 (23)	0.3
	Prolapse all the time	20 (17)	14 (17)	34 (17)	1.0
Type of prolapse	Full thickness	98 (84)	73 (88)	171 (86)	0.5
	Internal prolapse	19 (16)	10 (12)	29 (15)
Co-existing urinary incontinence	Yes	57 (49)	39 (47)	96 (48)	0.8
	Unknown	2 (2)	3 (4)	5 (3)
Recurrent rectal prolapse		30 (26)	20 (24)	50 (25)	0.9

¹Fisher’s exact test.

NPD: No psychiatric disorders; PD: Psychiatric disorders.

Table 4 Pelvic Floor Distress Inventory Questionnaire

		NPD (n = 117)	PD (n = 83)	P value1	Difference in medians (95%CI)2
PFDI-20	Median (IQR)	101.04 (67.71, 150.00)	137.50 (77.08, 180.21)	0.035	38.24 (3.71-53.96)
Pelvic Organ Prolapse Distress Inventory	Median (IQR)	25.00 (16.67, 41.67)	33.33 (16.67, 50.00)	0.078	4.64 (-4.26 to 15.83)
Colorectal-Anal Distress Inventory	Median (IQR)	50.00 (34.38, 68.75)	62.50 (43.75, 81.25)	0.007	11.33 (-1.43 to 22.51)
Urinary Distress Inventory	Median (IQR)	25.00 (8.33, 45.00)	29.17 (16.67, 62.50)	0.12	4.39 (-3.71 to 18.88)

¹Wilcoxon test.

²Based on quantile regression models adjusted for age, history of chronic constipation, history of chronic diarrhea, and history of sexual trauma.

NPD: No psychiatric disorders; PD: Psychiatric disorders; CI: Confidence interval; IQR: Interquartile range; PFDI-20: Pelvic Floor Distress Inventory Questionnaire-20.

Table 5 Pelvic Floor Impact Questionnaire

		NPD (n = 113)	PD (n = 80)	P value1	Difference in medians (95%CI)2
PFIQ	Median (IQR)	80.95 (38.10, 142.86)	100.00 (59.52, 171.43)	0.024	16.19 (-10.47 to 51.29)
Urinary Impact Questionnaire	Median (IQR)	11.11 (0.00, 38.10)	23.81 (0.00, 52.38)	0.068	14.12 (1.52-23.63)
Colorectal-Anal Impact Questionnaire	Median (IQR)	47.62 (28.57, 80.95)	66.67 (40.48, 85.71)	0.027	14.29 (2.93-29.69)
Pelvic Organ Prolapse Impact Questionnaire	Median (IQR)	0.00 (0.00, 33.33)	4.76 (0.00, 50.00)	0.194	4.76 (-1.49 to 19.82)

¹Wilcoxon test.

²Based on quantile regression models adjusted for age, history of chronic constipation, history of chronic diarrhea, and history of sexual trauma.

NPD: No psychiatric disorders; PD: Psychiatric disorders; CI: Confidence interval; PFIQ: Pelvic Floor Impact Questionnaire; IQR: Interquartile range.

Table 6 Cleveland Clinic Fecal Incontinence and Obstructed Defecation Syndrome scores

		NPD	PD	P value1	Difference in medians (95%CI)2
CCFI score	n	114	83
	Median (IQR)	14 (8, 16)	13 (9, 17)	0.525	0.11 (-1.95 to 1.74)
ODS score	n	115	83
	Median (IQR)	7 (4, 12)	9 (5, 13)	0.024	1.37 (-1.29 to 3.16)

¹Wilcoxon test.

²Based on quantile regression models adjusted for age, history of chronic constipation, history of chronic diarrhea, and history of sexual trauma.

NPD: No psychiatric disorders; PD: Psychiatric disorders; CI: Confidence interval; CCFI: Cleveland Clinic Fecal Incontinence; ODS: Obstructed Defecation Syndrome; IQR: Interquartile range.