更新于：2024-09-19

Rectal Prolapse

直肠脱垂

更新于：2024-09-19

基本信息

别名

Procidentia of rectum、Procidentia, rectum、Prolapse of rectal mucosa

+ [33]

简介

Protrusion of the rectal mucous membrane through the anus. There are various degrees: incomplete with no displacement of the anal sphincter muscle; complete with displacement of the anal sphincter muscle; complete with no displacement of the anal sphincter muscle but with herniation of the bowel; and internal complete with rectosigmoid or upper rectum intussusception into the lower rectum.

关联

项与直肠脱垂相关的药物

Yizi Decoction

乙字汤

靶点-

作用机制-

在研机构

Sanwa Shoyaku Co., Ltd.

原研机构

Sanwa Shoyaku Co., Ltd.

在研适应症

出血 [+3]

非在研适应症-

最高研发阶段批准上市

首次获批国家/地区

日本

首次获批日期1986-07-18

项与直肠脱垂相关的临床试验

NCT06245577 / RecruitingN/A

Prospective Randomized Pilot Study on the Use of Biological Mesh Versus Synthetic Mesh in Interdisciplinary Resection Rectopexy With Sacro Colpopexy

The purpose of the pilot study is to demonstrate the safety and efficacy of a biological mesh compared to a standard synthetic mesh for the planned procedure in the above-mentioned clinical picture. Subsequently, a multicentre, randomized intervention study is planned to confirm the results and evaluate the long-term outcomes.

开始日期2024-01-30

申办/合作机构-

NCT06430931 / RecruitingN/A

Biological OviTex Versus Synthetic Graft in Robotic Prolapse Surgery: a Multicentre, Phase 11-111, Partially Randomised Patient Preference Trial

This prospective study aims to assess the efficacy of the OviTex 1S permanent mesh in pelvic floor surgery in comparison with the current standard polypropylene mesh.

开始日期2023-12-06

申办/合作机构

Health~Holland

NCT05918367 / RecruitingN/AIIT

Multicenter Ventral Mesh Rectopexy Registry Collaborative

The goal of this multicenter observational study is to collect data prospectively of patients with pelvic organ prolapse undergoing ventral mesh rectopexy (as well as rectoceles, entero-/sigmoidoceles/ intussusception/ rectal prolapse or combined) by laparoscopy or robotic surgery and to evaluate the longterm functional outcomes.
Secondly complications (mesh erosions, recurrence, reoperations) are evaluated.
Following main questions will be analysed - other can follow in consultation with the collaborative
1. Is VMR the technique of choice for treatment of rectoceles? Functional results - recurrence - mesh related complications
2. Has a perineal descent an impact on the functional outcome of ventral mesh rectopexy perfored for external rectal prolaps, internal rectal prolaps, rectocele, enterocele, sigmoidcele or combined pelvic organ prolapse?

开始日期2023-09-25

申办/合作机构-

100 项与直肠脱垂相关的临床结果

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100 项与直肠脱垂相关的转化医学

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0 项与直肠脱垂相关的专利（医药）

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3,551

项与直肠脱垂相关的文献（医药）

2024-02-25·Zhonghua fu chan ke za zhi

[Lower urinary tract injury in transvaginal reconstructive pelvic surgery].

Article

作者: W J Shen ; Y X Lu ; K Niu ; Y H Zhang ; W Y Wang ; Y Zhao ; J Ge ; X L Zhang

Objective: To explore the characteristics, prevention and treatment strategies of lower urinary tract injury in transvaginal reconstructive pelvic surgery (vRPS). Methods: A retrospective analysis was conducted on 24 patients who suffered lower urinary tract injuries occuring in vRPS from January 2005 to June 2021, among which 4 cases were referred to our hospital from other hospitals. Results: (1) In our hospital, 1 952 patients underwent vRPS for anterior and (or) middle pelvic organ prolapse during that study period, with a 1.0% (20/1 952) incidence of lower urinary tract injuries occurring in 20 cases. (2) Ureteral injuries were observed in 14 cases who underwent transvaginal high uterosacral ligament suspension (1.4%, 14/966). The symptoms were relieved after the removal of sutures. (3) Bladder injuries occurred in 6 cases in our hospital, with 4 cases (0.7%, 4/576) in anterior transvaginal mesh surgery (aTVM), one (0.4%, 1/260) in colpocleisis, and one (0.7%, 1/150) in apical suspension for fornix prolapse. An additional 4 cases of bladder injury were referred to our hospital after aTVM. Among the 8 cases of bladder injury during aTVM, 2 cases were intraoperative incidents. Cystoscopy confirmed that the superficial branch or puncture rod of anterior vaginal mesh had penetrated into the bladder. Re-puncturing and placement of the mesh were successfully performed. No abnormalities were observed during a follow-up period of 4-5 years. Postoperative bladder injuries were identified in 6 cases, characterized by mesh erosion into the bladder and formation of calculi. These injuries were confirmed between 6 months to 2 years after vRPS. The exposed mesh and calculi in the bladder were removed through laparotomy or cystoscopy, followed up for 2-12 years. One case experienced slight re-erosion of mesh to the bladder. Conclusions: Lower urinary tract injuries are difficult to avoid in vRPS, particularly in transvaginal high uterosacral ligament suspension and aTVM. However, the incidence is low. Lower urinary tract injuries during vRPS could be easily detected and managed intraoperatively because of the use of cystoscopy. As long-term postoperative complications, erosion of transvaginal mesh to lower urinary tract postoperatively could be treated correctly, seldom with severe sequelae.

2024-02-23·Langenbeck's archives of surgery

Mental health disorders as a risk factor in young patients with rectal prolapse.

Article

作者: Ashlyn E Whitlock ; Kevin R Arndt ; Benjamin G Allar ; Michelle N Fakler ; Thomas E Cataldo ; Kristen T Crowell ; Anne C Fabrizio ; Evangelos Messaris

BACKGROUND:

Rectal prolapse (RP) typically presents in the elderly, though it can present in younger patients lacking traditional risk factors. The current study compares medical and mental health history, presentation, and outcomes for young and older patients with RP.

METHODS:

This is a single-center retrospective review of patients who underwent abdominal repair of RP between 2005 and 2019. Individuals were dichotomized into two groups based on age greater or less than 40 years.

RESULTS:

Of 156 patients, 25 were < 40. Younger patients had higher rates of diagnosed mental health disorders (80% vs 41%, p < 0.001), more likely to take SSRIs (p = .02), SNRIs (p = .021), anxiolytics (p = 0.033), and antipsychotics (p < 0.001). Younger patients had lower preoperative incontinence but higher constipation. Both groups had low rates of recurrence (9.1% vs 11.6%, p = 0.73).

CONCLUSIONS:

Young patients with RP present with higher concomitant mental health diagnoses and represent unique risk factors characterized by chronic straining compared to pelvic floor laxity.

2024-02-15·Clinical and translational gastroenterology

Clinical outcomes before and after prucalopride treatment: an observational study in patients with chronic idiopathic constipation in the USA.

Article

作者: Anthony Lembo ; Brooks D Cash ; Mei Lu ; Emi Terasawa ; Brian Terreri ; Shawn Du ; Rajeev Ayyagari ; Paul Feuerstadt ; Baharak Moshiree ; Ben Westermeyer ; Selina Pi ; Mena Boules

INTRODUCTION:

This real-world US-based claims study compared constipation-related symptoms and complications 6 months before and after prucalopride initiation in adults with chronic idiopathic constipation (CIC).

METHODS:

This observational, retrospective cohort analysis used the IBM MarketScan® Commercial Claims and Encounters and the Medicare Supplemental databases (January 2015-June 2020). Prucalopride-treated patients (≥18 years old) who had ≥1 constipation-related International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis code during the baseline or study period were included. The proportions of patients with constipation-related symptoms (abdominal pain, abdominal distension [gaseous], incomplete defecation, and nausea) and constipation-related complications (anal fissure and fistula, intestinal obstruction, rectal prolapse, hemorrhoids, perianal venous thrombosis, peri-anal/peri-rectal abscess, and rectal bleeding) were examined. Constipation-related symptoms and complications were identified using ICD-10-CM, ICD-10-Procedure Coding System, or Current Procedural Terminology codes. Data were stratified by age (overall, 18-64 years, ≥65 years).

RESULTS:

This study included 690 patients: mean (standard deviation) patient age was 48.0 (14.7) years and 87.5% were women. The proportions of patients overall with constipation-related symptoms decreased 6 months after prucalopride initiation (abdominal pain [50.4% vs 33.3%, P<0.001]; abdominal distension [gaseous] [23.9% vs 13.3%, P<0.001]; and nausea [22.6% vs 17.7%, P<0.01]; no improvements observed for incomplete defecation). Similarly, the proportions of patients overall with constipation-related complications decreased 6 months after prucalopride initiation (intestinal obstruction [4.9% vs 2.0%, P<0.001]; hemorrhoids [10.7% vs 7.0%, P<0.05]; and rectal bleeding [4.1% vs 1.7%, P<0.05]).

DISCUSSION:

This study suggests that prucalopride may be associated with improved constipation-related symptoms and complications 6 months after treatment initiation.

项与直肠脱垂相关的新闻（医药）

2024-02-18

·药智网

“全球药企一哥”的新下注方向

GLP-1领域的无敌之姿，也让礼来和诺和诺德登上了全球前二大市值药企，两者市值分别为7189.2亿美元、5493.95亿美元。更可怕的地方在于，“礼诺”正在不断的迭代和丰富自己的GLP-1布局，举措不仅包括广开新适应症、开发双&三靶点更强效果的分子、开发不同剂型的GLP-1药物及BD组合疗法伙伴。在投资者对于GLP-1资产市值上限和空间踌躇之时，新的减重伴生投资机会又在哪里？近期以来，礼来通过以19.25亿美元收购Versanis、投资BioAge Labs并计划联用其核心产品开展二期临床这两个动作，揭示了“全球药企一哥”全新的代谢领域下注方向：降脂增肌。01循环减重危害引发的全新需求众所周知，GLP-1减重药最大的软肋是“停药反弹”和“需长期服药”，对于利用GLP-1药物“循环减重”或者“间歇性用药”的患者人群十分不友好。对于GLP-1药物停药反弹想再次减重的患者来说，减重时除了失去脂肪还失去了肌肉，而体重反弹时他们恢复的只是脂肪；长此以往，“循环减肥”将渐进的改变这类人群的身体构成，身体的脂肪含量会越来越高，肌肉将越来越少。正因GLP-1类药物存在这类局限性，如何更高质量的减肥成了时下的热门研发领域。那么，肌肉流失的危害有多大？肌肉组织不仅支撑人类个体的日常运动，还起到帮助人体吸收营养物质并代谢掉体内的废物等功能。肌肉流失除了带来日常活动及体运动能力的下降，还会来带代谢改变、骨质疏松风险增加和免疫功能下降等危害。上述危害可能代表增加各类疾病的患病的风险，仅以肌肉的承重能力对应潜在疾病而言，当肌肉流失严重时，可能会发生如子宫脱垂、直肠脱垂等疾病，若流失的是心脏肌肉，还可能出现心肺功能减弱、心肺衰竭等危急情况。02百花齐放趋势的增肌减脂靶点降脂增肌作为新一代减肥药物或伴侣的研发方向，全球在研的靶点并不在少数，包括肌肉生长抑制素、雄激素受体调节剂、代谢调控加速器等，本文重点聚焦礼来系已经重点下注肌肉生长抑制素和艾帕素领域（ActRII受体和apelin受体靶点）。肌肉生长抑制素（MSTN）是一种限制骨骼肌然蛋白质（ActRII是MSTN主要受体），部分研究表明：其较高活性能够抑制骨骼肌的增长（研究表明敲除MSTN基因的小鼠肌肉质量增加25-30%），过去一直是神经肌肉疾病中治疗脊髓性肌萎缩症（SMA）的重要研究方向。图片来源：太平洋证券近年来，MSTN抑制剂的研发正好与目前减重药物的缺陷形成“互补”的曙光。一方面，MSTN抑制剂可能影响代谢过程，有助于调节能量平衡和代谢；另一方面，MSTN抑制剂对增加肌肉质量可能有帮助，可增加能量消耗进而有助于减少人体脂肪，达到此消彼长的目的。艾帕素（Apelin）是一种因运动而释放分泌的多肽，它通过与骨骼肌、心脏、和中枢神经系统的相互作用调节新陈代谢，调节新陈代谢并促进肌肉再生。BioAge的研究显示，人的一生中，总体Apelin水平会逐渐下降，而Apelin水平较高的人具有更强的身体功能和更长的寿命。从全球相关靶点研发进度看，MSTN抑制剂有较多临床在研产品，但核心适应症以肌肉萎缩相关适应症为主；而Apelin受体激动剂全球进入临床阶段的分子较少，BioAge的Azelapra进度领先。靶向肌肉生长抑制素疗法不完全统计图片来源：吉满生物礼来收购的Versanis靶向ActRII受体抑制剂Bimagrumab已经收获了非常积极的数据。据Versanis早前公布的48周二期临床针对2型糖尿病的超重或肥胖患者数据显示，相比安慰剂，尽管Bimagrumab治疗组的体重虽只下降了6.5%，造成患者约22%脂肪含量的丢失，并且增加4.5%的无脂体重。更重要的是，相比一般的GLP-1药物，Bimagrumab治疗组患者停止治疗12周内并未观察到体重的增加。而另一边礼来投资的BioAge，在一项227名65岁及以上的老年人的早期临床试验表明：Apelin受体激动剂Azelaprag可预防老年人的肌肉萎缩。从Bimagrumab到Azelaprag两款产品布局，我们可以看到礼来迭代、揽全的多点出击思维，但前者为单抗，后者为小分子，也考虑到了未来患者的依从性需求。03国产分子的机会相对于火热的减重，降脂增肌这样新兴而差异化的领域在国内显得更加的“先进而有价值”。目前从全球来看，ActRII和apelin两个靶点的竞争格局十分良好，尽管前者在研相关药物较多，但适应症以血液病、肺动脉高压、癌症为主，表现形式以ActRIIA/B融合蛋白为主；真正进入临床研究的、有计划以肥胖为适应症的ActRII抗体，仅有Versanis/礼来的Bimagrumab和来凯医药的LAE102；后者而言，前面提到BioAge的Azelapra可能是唯一一个进入临床的apelin激动剂。图片来源：太平洋证券对于国内Biotech来凯医药而言（不止于某家公司，而是针对ActRII靶点开发后来者），LAE102是存在较大突围机会的，原因有几个：1）礼来收购的Bimagrumab原研为诺华公司，原本针对一种罕见的肌肉萎缩疾病（散发性包涵体肌炎）治疗的中后期临床失败，转而进行减重适应症的研究（后Versanis从诺华手中收购）。也就是说，原本该药物并非以减重适应症为前期研发导向，后来me better分子有很大优化空间；2）Bimagrumab在安全性上也有优化空间，诺华2021年在JAMA发表的Bimagrumab临床数据显示：其核心不良事件是轻度腹泻(41%vs 11%)和肌肉痉挛(41%vs 3%)，尤其是首次给药后腹泻频率最高，后逐渐减少。3）另外针来凯医药的LAE102，其创始人吕博为Bimagrumab的共同发明者，可能对该靶点有更深的理解，或者对改良该靶点的管线有更强的优势。除了来凯医药之外，翰森药业也留意到了激活素（ActRII）受体靶点带来的广谱疾病治疗的机会。2021年12月翰森药业以2000万美金加高达1.705亿美元里程碑从Keros引入KER-050，该产品是一种“工程化的配体捕获体”，由经修饰的TGF-β受体（即激活素受体IIA型）配体结合区域与人源抗体的Fc区域融合而成，用于治疗骨髓增生异常综合征（MDS）和骨髓纤维化患者血细胞减少等领域患者。对于国内的创新药企业来说，减重药“伴侣”管线是能够获得MNC补全代谢领域布局的热门方向，也是全新的方向，存在巨大的机会。结语：华创医药从基于肌肉萎缩的抗衰治疗需求、消费者对于塑型的医美需求等分析指出，增肌本身便是有望和减肥相媲美的巨大蓝海市场；而从现已发现的ActRII、apelin等靶点潜力来看，随着癌症、肌肉萎缩疾病、肺动脉高压和代谢等适应症治疗潜力的逐步兑现，上述的展望并非是一句空话。来源 | 瞪羚社（药智网获取授权转载）撰稿 | Kris.责任编辑 | 八角声明：本文系药智网转载内容，图片、文字版权归原作者所有，转载目的在于传递更多信息，并不代表本平台观点。如涉及作品内容、版权和其它问题，请在本平台留言，我们将在第一时间删除。商务合作 | 张武龙 13368443108（同微信）阅读原文，是昨天最受欢迎的文章哦

并购临床2期

2023-10-29

·生物谷

长期便秘竟会影响认知功能？哈佛大学等机构研究发现：每3天或更长时间排便者，客观认知功能明显恶化，相当于衰老3岁！

便秘，一种难以言说的痛，困扰着不少朋友。虽然说人类的悲喜并不相通，但在便秘这件事情上，大概是相通的，使出“洪荒之力”，却依然“颗粒无收”，那种在厕所经经历地老天荒的感觉并不好受。偶尔一次的排便费劲儿，并不属于便秘。便秘是指每周排便少于3次、粪便干硬、排便困难。偶尔发生便秘是常见现象，但当便秘持续＞12周则为慢性便秘。众所周知，长期便秘对身体危害很大，比如腹痛腹胀影响生活质量，诱发混合痔、肛裂和直肠脱垂等。那么问题来了，排便次数可能还会影响认知功能，您知道吗？近日，美国马萨诸塞大学、哈佛大学等单位联合在知名期刊Neurology发表了一篇研究论文，题目为“Association Between Bowel-Movement Pattern and Cognitive Function: Prospective Cohort Study and a Metagenomic Analysis of the Gut Microbiome”，结果发现，与每日排便一次者相比，每3日或更长时间才排便的受试者认知功能明显更差，相当于认知功能衰老三年，其可能与肠道微生物菌群和特定微生物种类显著相关。doi: 10.1212/WNL.0000000000207849在这项前瞻性研究中，研究人员调查了护士健康研究II（NHSII）中12696名女性受试者排便频率与客观测量认知功能的关系；以及来自护士健康研究（NHS）、NHSII和卫生专业人员随访研究（HPFS）三个队列研究的113145名女性和男性受试者排便频率与主观认知功能的关系。并在探索性分析中，深入研究了来自NHSII和HPFS的515名受试者的排便频率、肠道微生物群和主观认知功能之间的相互关系。研究者将研究人群按照排便频率分为四类：每三天或更久，每隔一天，每天，每天两次或更多次。在排便频率评估时，NHS研究人群的平均年龄为75.7岁，NHSII为58.6岁，HPFS为74.5岁。报告显示，排便频率较高的参与者膳食纤维摄入量较高，使用泻药的频率较低。与那些每天排便一次的人相比，排便频率或多或少的参与者身体活动较少，更有可能出现抑郁症状并使用抗抑郁药。研究者使用CogState计算机神经心理评价软件来评估客观认知功能，研究显示，在对潜在混杂因素进行调整后，排便频率与客观认知功能呈现反J形剂量反应方式相关。并且学习和工作记忆以及精神运动速度和注意力也存在类似的剂量-反应关联。图：排便频率和客观认知功能的关联（来源：[1]）客观认知功能方面，与每日排便的受试者相比，排便频率为每3天或更长时间一次的受试者的认知恶化程度相当于衰老3.0岁。特别是在学习和工作记忆方面，排便频率为每3天或更长时间一次的受试者，其认知能力恶化相当于衰老7.1岁。主观认知能力下降是用一组是/否问题来评估的，包括NHSII和NHS的7个问题和HPFS的6个问题，涉及自我感知的近期记忆和认知变化。结果显示，在三个独立队列中，排便频率与主观认知能力下降剂量反应均呈反J型关系。图：排便频率和主观认知能力下降的关联（来源：[1]）主观认知功能方面，与每日排便者相比，排便次数最少（每3天或更长时间一次）和最多（每天两次或更多次）的受试人群，主观认知能力下降的几率分别高出73%和37%，并且，随着时间的推移，出现主观认知下降抱怨的可能性分别高出19%和10%。与此同时，排便频率与一般记忆、执行功能、注意力和视觉空间技能的长期恶化可能性之间也存在非线性剂量-反应关系。紧接着，研究人员还在515名受试者中探索了肠道微生物在排便频率和认知功能之间关系中的作用。研究者指出，虽然排便频率不是肠道微生物组成的主要驱动因素，但PERMANOVA显示，排便频率与肠道微生物组的整体变化之间存在显著关联，排便频率与PCo1呈显著非线性相关。此外，主观认知能力下降与肠道微生物组总体变异显著相关，与PCo1呈正相关。最终，研究者确定了19种与排便频率显著相关的微生物，15种与认知功能显著相关的微生物；3种微生物与排便频率和认知功能均显著相关，包括瘤状球菌、柠檬酸梭菌和厌氧杆菌（An250）。与生态失调相关的细络菌属，如细小弧菌、异速弧菌和非典型弧菌，是常见于口腔、肠道和泌尿生殖系统的革兰氏阴性和严格厌氧细菌，与更频繁的排便有关。图：排便频率、认知功能与肠道微生物群整体变化的关系（来源：[1]）在排便频率较低的受试者中，观察到Roseburia spp.丰度减少，包括R. inulinivorans和R. faecis等主要的丁酸盐产生细菌物种在内。在认知功能方面，条件致病菌丹毒弧菌Erysipelatoclostridium ramosum和厌氧细菌Blautia sp. CAG 257的富集与认知功能恶化有关。膳食纤维加工者和丁酸盐生产者Eubacterium eligens菌在认知功能较好的受试者体内含量更为丰富。总的来说，便秘人群要多注意，排便频率越低，客观测量的认知功能越差，主观认知能力下降的风险越高。与肠道微生物失调相关的促炎微生物物种的富集和产生丁酸盐的微生物的消耗可能部分解释了异常排便模式和认知功能之间的机制联系。无独有偶，我国的一项横断面研究[2]发现，中国老年人便秘的患病率较高，与认知健康的个体相比，痴呆和na-MCI（na-MCI）患者的便秘患病率更高。而香港中文大学医学院也曾发表一篇文章[3]，认为微生物群-肠-脑轴被认为在帕金森病（PD）中起重要作用，PD样肠道生态失调发生在PD的前驱阶段，与本研究有着异曲同工之意。由上所知，长期便秘病不是小事，与身体健康有着千丝万缕的联系，要引起足够重视，须改善生活方式并积极治疗。作者指出，本研究仍存在一定的局限性，需要更多的前瞻性研究来证实排便频率与认知功能之间的关联，并进一步阐明肠道微生物群在认知障碍和痴呆中的机制作用。参考文献：[1] Ma C, Li Y, Mei Z, Yuan C, et al. Association Between Bowel-Movement Pattern and Cognitive Function: Prospective Cohort Study and a Metagenomic Analysis of the Gut Microbiome. Neurology. 2023 Sep 29:10.[2] Wang F, Fei M, Hu WZ, et al. Prevalence of Constipation in Elderly and Its Association With Dementia and Mild Cognitive Impairment: A Cross-Sectional Study. Front Neurosci. 2022 Jan 24;15:821654.[3] Huang B, Chau SWH, Liu Y, et al. Gut microbiome dysbiosis across early Parkinson's disease, REM sleep behavior disorder and their first-degree relatives. Nat Commun. 2023 May 2;14(1):2501.撰文 | 青叶编辑 | 小白精彩推荐：1、别吃得太精细！BMJ：超13万人数据研究揭示摄入高质量碳水化合物有助减肥、延长寿命！2、恋爱选择相似or互补的人？Nature子刊研究近8万对情侣发现，相似度80%以上的人更容易成为伴侣3、久坐伤身不用怕！《英国运动医学杂志》发现每天只需这样运动22分钟即可抵消久坐带来的死亡风险4、爱吃鸡蛋的人注意了！我国学者最新研究：冠心病高遗传风险者或应少吃鸡蛋，每周增加3个鸡蛋冠心病风险增加10%！5、痴呆能“转移”？最新报道：首次证实阿尔茨海默病症状可通过肠道微生物群转移到健康生物体！本文仅用于学术分享，转载请注明出处。若有侵权，请联系微信：bioonSir 删除或修改！

临床研究微生物疗法

2022-11-22

·Science Daily

Birth choices after previous cesarean and risk of pelvic floor surgery

Vaginal birth after a previous cesarean section is associated with an increased risk of pelvic floor surgery compared with planning another cesarean, according to a new study. The findings provide useful information to help women who have had a previous cesarean section when planning how to give birth in their next pregnancy. Vaginal birth after a previous cesarean section is associated with an increased risk of pelvic floor surgery compared with planning another cesarean, according to research publishing November 22 in the open access journal PLOS Medicine. The findings provide useful information to help women who have had a previous cesarean section when planning how to give birth in their next pregnancy. Cesarean section births have risen sharply around the world: in the UK over 30% of all births now occur in this way. Guidelines recommend that pregnant women be counseled on the associated risks and benefits of subsequent births after a cesarean compared with planning a vaginal birth so they can make an informed decision about this choice. Yet there is limited evidence about how this choice affects women's risk of pelvic floor disorders, including pelvic organ prolapse, urinary incontinence, rectal prolapse and fecal incontinence. Dr Kathryn Fitzpatrick of Oxford Population Health, University of Oxford, UK, and colleagues conducted a cohort study of 47,414 births in Scotland to women with one or more previous cesarean sections. All births took place between January 1983 and December 1996, were at full term and were for just one baby. Almost 67% planned for a vaginal birth after a cesarean and 33% planned another cesarean. Having followed up with women for an average of just over 22 years, 1,159 had pelvic floor surgery, and this was more than twice as likely in women who planned a vaginal birth: over 1,000 person-years, the rate was 1.75 in the planned vaginal birth group and 0.66 in the women who planned another cesarean. The risk of surgery for pelvic organ prolapse was three times more likely and urinary incontinence was twice as likely in those who planned a vaginal birth (hazard ratios of 3.17 and 2.26 respectively). The risks were only elevated in women who gave birth vaginally as planned. Those who planned a vaginal birth but had an unplanned cesarean when they were in labor had a comparable risk with those who planned another cesarean. The authors hope that their research will provide useful information for women who have had previous cesarean sections when making future birth choices. Dr Kathryn Fitzpatrick who led the study adds, "Our study shows that for pregnant women who have had a caesarean birth in the past, those who have a vaginal birth rather than plan another caesarean are more likely to go on to have an operation for some type of pelvic floor disorder such as urinary incontinence. Our findings provide important new information to counsel the increasing numbers of women who have had a caesarean birth in the past about the risks and benefits associated with their future birth choices."