S346 Pelvic Floor Dysfunction Is a Common Cause of Chronic Constipation: A Retrospective Review of Patients Referred to a Tertiary Center for Constipation

Introduction: Pelvic floor dysfunction (PFD) is a common, yet underrecognized cause of chronic constipation. A delay in diagnosing PFD can lead to patient dissatisfaction and increased healthcare costs. Our aim was to evaluate rates and predictors of PFD in patients referred for tertiary evaluation of chronic constipation. Methods: This was a retrospective study of patients referred to Mayo Clinic Florida for constipation between September 2023 and May 2024. Baseline characteristics, testing, final diagnosis, and recommended treatments were recorded. Continuous variables were summarized as median (range) and mean (SD) and categorical variables were reported as frequency (%). Continuous variables were compared using Wilcoxon rank sum test and categorical variables were compared using Fisher’s exact test. Results: Among the 314 patients included in the final analysis, 68.2% (n = 214) were diagnosed with PFD. Patients diagnosed with PFD were significantly younger (mean age 49.7 years vs 55.5, P = 0.002) and more often had one or more vaginal delivery (32.7% vs 21.0%, P = 0.034), particularly complicated vaginal deliveries (10.3% vs 1.0%, P = 0.002). Patients with PFD also more often had pelvic organ prolapse (14.0% vs 3.0%, P = 0.003) and irritable bowel syndrome with constipation (39.7% vs 21.0%, P = 0.001). There were no significant differences in gender, psychiatric comorbidities, or abdominal/pelvic surgeries between the 2 groups. Patients with PFD more often reported straining (57.0% vs 31.0%, P < 0.001), a sensation of incomplete evacuation with defecation (61.71% vs 26%, P < 0.001), need for manual maneuvers (18.2% vs 8.0%, P= 0.018), and difficulty voiding urine (13.1% vs 5.0%, P= 0.30). Patients with PFD were more likely to have previously been treated with secretagogues (38.3% vs 22.0%, P= 0.005). Rectal exam was more often abnormal (21.6% vs 4.0%, P < 0.001). Finally, pelvic floor physical therapy was more often recommended in patients with PFD (87.9% vs 2.0%, P < 0.001), while medications were more often prescribed in patients without PFD (91.0% vs 61.0%, P < 0.001). Conclusion: The majority of patients referred for tertiary evaluation of chronic constipation were diagnosed with PFD. PFD is more common in younger patients with a history of complicated vaginal delivery, pelvic organ prolapse, irritable bowel syndrome with constipation, and in patients reporting straining, incomplete evacuation, the use of manual maneuvers, and difficulty voiding urine. A rectal examination can help to distinguish patients with PFD.