Functional bowel disorders in pregnancy: effect on quality of life, evaluation and management.

OBJECTIVE: To characterize functional bowel disorders in a population of pregnant women, evaluating effects on quality of life, management and follow up. DESIGN: Prospective cohort. SETTING: University center, USA. POPULATION: Women in the first trimester (n = 104). METHODS: After enrollment evaluations, measures were repeated in the third trimester. Overall bowel function was assessed using the Rome III Questionnaire for Functional Bowel Disorders. Quality of life symptoms were assessed with the Irritable Bowel Syndrome Quality of Life Measure. Physician documentation of bowel symptoms and subsequent treatment in pregnancy were ascertained by retrospective chart review. MAIN OUTCOME MEASURE: Quality of life in first trimester. RESULTS: A majority (75%) of the women at the first trimester evaluation reported having one or more functional bowel disorders. The overall quality of life status was rated highly functional, with a total average score of 94.9. Of the 75 women reporting functional bowel disorders, only 18 (24%) were identified in the medical record. Overall documentation of any bowel function was identified in the majority (64%) of cases. Most commonly, no discussion of treatment was documented, and follow up was recorded in only 27% of women with dysfunction. CONCLUSIONS: Nearly three-quarters of women in the first trimester report symptoms consistent with functional bowel disorders. Overall quality of life measures are highly rated. There is a discrepancy between what women report regarding bowel dysfunction and what is documented by providers within the medical record.

Self-reported natural history of recurrent prolapse among women presenting to a tertiary care center.

OBJECTIVE: To describe the characteristics of recurrent pelvic organ prolapse (POP). METHODS: A convenience sample of patients presenting with recurrent POP symptoms between October 2007 and February 2010 completed questionnaires. The survey focused on timing of recurrence(s), symptoms, and demographics. RESULTS: Ninety-seven women completed questionnaires. Thirty-four (35.1%) had undergone multiple prior treatments. Overall, 23 of 76 (30.3%) women had not informed their surgeon of the recurrence. Twenty-seven of 59 (45.8%) women reported that their symptoms were the same as before treatment, whereas 23 of 59 (39.0%) reported more severe symptoms. POP was considered to be persistent if symptoms returned within 3 months, and recurrent if symptom relief exceeded 3 months. After primary surgery, 28 of 79 (35.4%) cases were considered to be persistent, whereas 51 (64.6%) cases were recurrent. Similar percentages were seen after second and third treatments. CONCLUSION: Overall, 35% of participants experienced early return of symptoms. Almost one-third of participants had not informed their surgeon of the recurrence, indicating that there may not be an accurate self-assessment of outcome in the absence of careful follow-up.