Exploring factors that influence women’s self-management of rectal emptying difficulty

Abstract

Aim The aim of this study was to pragmatically investigate a vital element of bowel function, where emptying the rectum is difficult in women, usually because of obstructive defaecation, secondary to rectocele.

Background Rectal emptying difficulty in women is a sign of obstructive defaecation, which affects about one out of every ten women and can increase with age. Rectal emptying difficulty has a mostly unknown influence on women, and it is frequently a hidden issue. Women's self-management alternatives are underappreciated, as is the impact of such interventions on their quality of life. Despite the magnitude of the problem and its influence on women's lives and health care, non-surgical alternatives have received little attention.

Methods The research consisted of an exploratory phase of nine self-selecting women who had self-purchased the patient-centred device. This was followed by a mixed-method study, using an explanatory sequential approach with 35 female participants, recruited via secondary care outpatient clinics. The participants completed a composite questionnaire before and after an eight-week intervention using a patient-centred device, an alternative to using their fingers to help empty the rectum. The questionnaire comprised of a quality-of-life instrument (ICIQ-Vaginal Symptoms and Obstructed Defaecation Syndrome Questionnaires), bowel diary recordings and participant feedback on using the device. The majority of the same participants (n=26) subsequently took part in a semi-structured interview.

Findings The exploratory phase provided preliminary insight into self-initiated use of the patient-centred device, suggesting an improved quality of life and a reduction of symptoms. The questionnaire result from the mixed methods study identified that the patient-centred device helped participants reduce the need to use their fingers (z=-2.844; p=0.004) and offered the participants a better lifestyle. There was a significant reduction in difficulties to evacuate, digitation to evacuate, the feeling of incomplete evacuation, straining to evacuate and lifestyle alteration, all below the threshold of significance (P=0.05). Medication to evacuate, returning to the toilet to evacuate and time needed showed no difference. The sense of incomplete emptying before and after using the device was significant (z=-2.646; p=0.008) as was the feeling of being blocked, which improved following the use of the device (z=-3.317; p=0.001). Stool consistency did not change before or after using the device. Twenty-four participants (68.5%) completed the Patient Global Impression of Improvement question post-intervention. Overall, 16 participants (66.7%) reported that the device was better than not using it. Using framework analysis interview findings revealed six themes, knowledge, consequences, finding a solution, psychological impact, coping, and physical impact. The mixed-methods study showed that the patient-centred device was acceptable to participants.

Conclusions The research study has contributed to the existing body of knowledge on rectal emptying difficulty in women. Firstly, the effectiveness of a patient-centred device for women with rectal emptying difficulty to use as an alternative for using their fingers to help empty the rectum. Furthermore, it offers an additional conservative measure option within healthcare provision. Second, the participants' lived experiences can help healthcare professionals, such as women who report with a bowel problem, learn more about rectal emptying difficulty, which can improve quality of life and prompt access to care. The research has strengthened the feasibility for further investigation via a randomised controlled trial.