Pelvic organ prolapse (POP) surgery aims to restore anatomy, yet its effect on bowel function remains uncertain. The integral theory of the pelvic floor suggests that restoration of ligamentous support, particularly uterosacral ligaments, may improve bowel symptoms including fecal urgency and incontinence (1–3). This study aimed to evaluate whether apical prolapse correction is associated with improvement in bowel function following sacrospinous fixation.

A retrospective clinical study was conducted including patients who underwent sacrospinous fixation between December 2024 and December 2025. Only patients with complete preoperative and postoperative data at 3-month follow-up were included in the analysis (n=14). POP-Q measurements (Aa, Ba, Ap, Bp, C) and bowel function scores, including LARS (Low Anterior Resection Syndrome score) and CCS (Cleveland Clinic Constipation Score), were recorded preoperatively and at 3 months postoperatively. Changes (Δ) in anatomical (ΔAa, ΔBa, ΔAp, ΔBp, ΔC) and functional parameters (ΔLARS, ΔCCS) were calculated. Correlations between anatomical correction and functional outcomes were assessed using Pearson correlation analysis.

LARS scores showed a non-significant improvement after surgery (16.6 vs 13.9, p=0.35), while CCS scores remained unchanged (p=0.51). Preoperative bowel dysfunction strongly predicted postoperative outcomes (LARS r=0.74; CCS total r=0.90). Apical correction (ΔC) showed no meaningful association with changes in bowel function (ΔLARS r=0.20; ΔCCS r=0.18). Anterior compartment changes demonstrated weak or no association with constipation (ΔBa r=−0.06; ΔAp r=−0.26), although ΔAp showed a moderate correlation with LARS (r=0.56). Posterior compartment restoration (ΔBp) showed the strongest association with improvement in constipation scores (ΔBp vs ΔCCS r=−0.53) and a moderate association with LARS (r=0.47). However, considerable variability was observed, with similar anatomical changes associated with differing functional outcomes.

Although urgency-related symptoms (LARS) showed a trend toward improvement after surgery, this improvement was not associated with the degree of apical correction and appeared to be influenced by changes across multiple pelvic compartments. In contrast, constipation outcomes demonstrated a compartment-specific pattern, with posterior compartment restoration showing the strongest association. Nevertheless, the observed variability indicates that anatomical correction alone does not fully explain bowel function outcomes, supporting a multifactorial mechanism. These findings provide partial support for the integral theory (1–3); however, the lack of correlation with apical correction suggests that mechanisms beyond uterosacral ligament restoration may play a more dominant role.

Apical prolapse correction alone does not predict improvement in bowel function. Urgency-related symptoms may be influenced by global pelvic floor changes, whereas improvement in constipation is more strongly associated with posterior compartment restoration. However, variability in outcomes suggests that bowel function is determined by both anatomical and multifactorial factors.

Petros PE. Cent European J Urol. 2010;64(1):104–107.
Petros PE, Richardson PA. Pelviperineology. 2008;27:111–113.
Abendstein B, et al. Pelviperineology. 2008;27:118–121.