Rectal Prolapse Repair Improves Bowel Symptoms in Women With Psychiatric Disorders: A Cohort Analysis of a Single-Center Registry.

Abstract

Background: Psychiatric disorders are prevalent in patients with rectal prolapse. While psychiatric disorders are associated with poor surgical outcomes and worse health in general, it is unknown how they impact rectal prolapse repair.

Objective: To determine rectal prolapse symptom severity in patients with psychiatric disorders and how surgical repair modified these symptoms.

Design: Retrospective analysis of a prospectively maintained database.

Settings: Academic colorectal practice.

Patients: Female patients with and without psychiatric comorbidities who underwent rectal prolapse repair with preoperative and 1-year postoperative Pelvic Floor Distress Inventory (PFDI-20) scores.

Main outcome measure: One-year change in PFDI-20 score.

Results: Of 365 female patients in our registry, 146 met inclusion criteria. 54 (36%) had a psychiatric disorder. Depression (66%) and anxiety (44%) were the most prevalent conditions. Patients with a psychiatric disorder were significantly younger (median [IQR] age: 61 [48, 67] vs. 70 [60,77], p<0.001) but otherwise had a similar prevalence of comorbidities such as cardiac disease. Preoperative symptom profile was similar, but patients with psychiatric disorders reported higher PFDI-20 scores reflecting greater prolapse-related distress (mean [SD]: 146 [70] vs 115 [55], p = 0.01). Postoperatively, PFDI-20 scores improved significantly in both groups (adjusted mean change from baseline for patients with rectal prolapse repair: psychiatric disorders: -88 [-130, -47] vs. no psychiatric disorders: -44 [-68, -19]). Models did not reveal statistically significant differential improvement between groups, though patients with psychiatric disorders tended to have greater improvement in their scores compared to patients without psychiatric disorders.

Limitations: Single-center study with limited data on psychiatric comorbidity severity and disease control.

Conclusions: Rectal prolapse patients with psychiatric disorders suffer from prolapse-related distress at baseline but experience significant improvement after surgical repair, suggesting that appropriate management of rectal prolapse can improve their quality of life. Long-term durability of symptom improvement should be the focus of further work. See Video Abstract.