INTRODUCTION: Constipation is a significant concern for patients and providers following pelvic reconstructive surgery, particularly following posterior colporrhaphy. Previous studies have evaluated various bowel regimens, without an established standard of care. Devices to improve the angle of defecation are a promising means to enhance function; however, this modality has not been assessed in the reconstructive surgery population. OBJECTIVE: To determine if a defecation posture modification device (DPMD) improves ease of first bowel movement following pelvic reconstructive surgery, specifically posterior colporrhaphy. METHODS: This was a randomized controlled trial of women undergoing posterior colporrhaphy, with or without concomitant repairs, between February 2024 and February 2025. Participants were randomized to receive a DPMD or no device. All participants were discharged with our standard postoperative pain medication and bowel regimen. Patients recorded their bowel symptoms for 7 days postoperatively. Our primary outcome was ease (or “strain”) with the first bowel movement on a 10-point scale. Secondary outcomes included pain, satisfaction, feeling of emptying with bowel movements, Bristol Stool Form Scale, narcotic and stool softener use, and satisfaction with the device. A sample size of 134 total, 67 per arm, was calculated to achieve 80% power to detect a clinically meaningful difference between both arms. RESULTS: One hundred and fifty patients were enrolled. Demographics between groups were similar; the majority were Caucasian, with a median age of 64 years. Seventy-one percent of patients had stage 2 prolapse or greater preoperatively. Ninety-seven percent underwent vaginal native tissue repair while 3% underwent mesh augmented repairs. For our primary outcome, there was no difference in ease of first bowel movement between arms, with the median level of strain noted as 2 out of 10. However, the vast majority, 81%, cited scores of 4 or less for this parameter, with a third of patients reporting no strain (0/10) with first bowel movement. There was no difference in level of pain (2/10) or satisfaction (6/10), a minority of patients felt fully empty after the first bowel movement. Most subjects documented stools as a 4 or higher on the Bristol Stool Form Scale (83%), indicating looser stools. When queried at the 2-week follow-up visit, most patients in the DPMD arm were satisfied with and still using their device, with 63% indicating they intended to continue use. Of note, some patients expressed concerns regarding the use of the device and discomfort in the early days following surgery. CONCLUSIONS: The use of a DPMD did not improve ease of first bowel movement after pelvic reconstructive surgery with posterior repair. Strain and pain were overall low in both arms, which may be related to a strict postoperative bowel regimen. Despite no difference in degree of strain, most patients found the device easy to use and planned to continue. Given patient-related concerns immediately post-surgery, and high satisfaction at the 2-week interval, use of a DPMD may be more appropriate outside the early postoperative period.Table 1Table 2
Carrel-Lammert et al. (Fri,) studied this question.