1. Assess the perineal body area before and after posterior colpoperineorrhaphy for prolapse  
2. Assess the bowel function before and after posterior colpoperineorrhaphy for prolapse

This was a prospective study of patients undergoing prolapse surgery. A clinical assessment and pelvic floor ultrasound were performed. Patients with previous hysterectomy were excluded from this study. The perineal body was measured before and after surgery with a validated technique (1). Birmingham Bowel and Bladder Symptom Questionnaires were administered before and after surgery (2).

79 patients were considered. 54 had posterior prolapse: 37% (20/54) had only posterior prolapse. 20% (11/54) patients had both anterior and posterior prolapse. 2% (1/54) patient had apical and posterior. 41% (22/54) had all anterior, apical and posterior. 

On linear regression analysis, there was a significant association between passive and urge faecal incontinence and a smaller perineal body area (p<0.0001) pre-operatively. The perineal body was significantly larger after posterior repair and perineorrhaphy surgery (2.56cm2+/-1.14 pre-op vs 3.68cm2+/- 0.87 post-op; WSR, p<0.0001). There was a significant improvement in BBBSQ scores for defaecation function, interms of straining (WSR, p=0.01), time spent in the toilet (WSR, p<0.001), digitation (WSR, p=0.03), dyschezia (WSR, p=0.02) and feeling of incomplete evacuation (WSR, p<0.0001). There was no change for faecal urgency (WSR, p=0.2), faecal incontinence (WSR, p0.8). There was one patient whose perineal body was normal on ultrasound pre-operative. She did not have symptoms of defaecation dysfunction pre-op. Post-operatively, she reported pain and difficulty with defaecation.

The perineal body was visualised and measured on 2D midsagittal sections. It was shown to be significantly larger after surgery. POP-Q PB has been shown to be simillar in prolapse and control patients (3). However, the size of the perineal body has been shown to be smaller in prolapse patients (1).Measuring the perineal body on ultrasound may be useful in prolapse patients to guide the pre-operative planning on whether to perform a perineorrhaphy.
The bowel symptoms related to the function of defaecation improved: less time spent in the toilet, less straining, less dyschezia, digitation and better evacuation. There was no improvement in faecal incontinence or faecal urgency.

A small perineal body can be restored with posterior repair and perineorrhaphy. Defaecation function improves after surgery in patients with corrected posterior compartment prolapse. Imaging pre-operatively could help provide information to guide the pre-op planning and MDT discussions. A comprehensive pre-operative assessment of symptoms and prolapse anatomy, could help improve prediction of symptom improvement (or deterioration). This would be useful in pre-operative counselling, informed consent, MDT discussion and operative planning.

Asfour, Victoria; Digesu, Giuseppe Alessandro; Fernando, Ruwan; u. a. (2019): „Ultrasound imaging of the perineal body: a useful clinical tool.“. In: International Urogynecology Journal. DOI: 10.1007/s00192-019-04166-7.
Hiller, L., Bradshaw, H. D., Radley, S. C., & Radley, S. (2002). A scoring system for the assessment of bowel and lower urinary tract symptoms in women. BJOG: an International Journal of Obstetrics & Gynaecology, 109(4), 424–430.
Digesu, G. A., Chaliha, C., Salvatore, S., Hutchings, A., & Khullar, V. (2005). The relationship of vaginal prolapse severity to symptoms and quality of life. BJOG: an International Journal of Obstetrics & Gynaecology, 112(7), 971–976. http://doi.org/10.1111/j.1471-0528.2005.00568.x

Continence 2S2 (2022) 100375
DOI: 10.1016/j.cont.2022.100375