Progression and remission of pelvic organ prolapse: A longitudinal study of menopausal women

doi:10.1016/j.ajog.2003.07.017

American Journal of Obstetrics and Gynecology

Volume 190, Issue 1, January 2004, Pages 27-32

https://doi.org/10.1016/j.ajog.2003.07.017 Get rights and content

Abstract

Objective

The purpose of this study was to describe the natural history of pelvic organ prolapse after menopause.

Study design

Over 2 to 8 years, participants in the estrogen plus progestin trial of the Women's Health Initiative at the University of California Davis had annual pelvic examinations, with an assessment of uterine prolapse, cystocele, and rectocele. The findings from these examinations were used to describe the incidence of pelvic organ prolapse, the probability of progression or regression, and the associated risk factors.

Results

At baseline, 31.8% of women had pelvic organ prolapse (n = 412 women). The annual incidences of cystocele, rectocele, and uterine prolapse were 9.3, 5.7, and 1.5 cases per 100 women-years, respectively. Incident prolapse was associated with increasing parity and waist circumference. The progression rates for grade 1 pelvic organ prolapse (per 100 women-years) were 9.5 for cystocele, 13.5 for rectocele, and 1.9 for uterine prolapse. The annual rates of regression (per 100 women-years) was 23.5, 22, and 48, respectively.

Conclusion

Our data suggest that pelvic organ prolapse is not always chronic and progressive as traditionally thought. Spontaneous regression is common, especially for grade 1 prolapse.

Section snippets

Study population

WHI is a prospective study of 161,861 postmenopausal women aged 50 to 79 years in ≥1 of 3 clinical trials or an observational study. These women were enrolled from 1994 to 1998 in 40 US clinical centers. The E-plus-P trial enrolled 27,342 women nationally. Women were eligible if they were postmenopausal, unlikely to move or die within 3 years, not currently using hormone replacement therapy (or willing to stop), and not currently participating in any other clinical trial. Women with a

Study population

The study cohort included 412 participants with two to eight annual examinations (mean, 5.7 examinations). Data from 2340 examinations were included in these analyses. The mean age at enrollment was 64.9 years (range, 50-79 years). Ninety percent of the cohort was white. Eighty-one percent of the cohort was parous, with a median parity of 3 (range, 0-8). The mean BMI at enrollment was 28.5 kg/m² (range, 15.0-49.1 kg/m²). The mean waist circumference was 89.1 cm.

Eighteen women (4.2%) who had

Comment

To our knowledge, only one previous longitudinal study of POP has been published.⁶ In that study, 241 women (aged 45-55 years) were followed up for 1 year but the incidence of prolapse was not reported. The mean Baden-Walker grade of anterior wall prolapse decreased from 0.2 to 0.1 (P = .045), and there was no change in the mean grades of posterior wall or uterine prolapse.

Our data, collected in several hundred women over 2 to 8 years, allows us a unique opportunity to investigate the incidence

References (14)

L.L Subak
Cost of pelvic organ prolapse surgery in the United States
Obstet Gynecol
(2001)
A.L Olsen
Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence
Obstet Gynecol
(1997)
S.E Swift
The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care
Am J Obstet Gynecol
(2000)
S.L Hendrix
Pelvic organ prolapse in the Women's Health Initiative: gravity and gravidity
Am J Obstet Gynecol
(2002)
E.C Samuelsson
Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors
Am J Obstet Gynecol
(1999)
D Bland
Use of the pelvic organ prolapse staging system of the International Continence Society, American Urogynecologic Society, and Society of Gynecologic Surgeons in perimenopausal women
Am J Obstet Gynecol
(1999)
R.C Bump
The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction
Am J Obstet Gynecol
(1996)

There are more references available in the full text version of this article.

Cited by (276)

Management of Rectocele with and without Obstructed Defecation
2023, Seminars in Colon and Rectal Surgery
Rectoceles are a common finding in female patients; they can be asymptomatic, or they can contribute to the sensation of pelvic pain, pressure, and difficulty with evacuation. Rectoceles coexist with anterior and mid compartment pelvic prolapse in up to 50% of patients. Defecatory dysfunction can be secondary to anismus, anatomic abnormalities such as rectocele or intussusception, and often are due to a complex interplay of both structural and functional abnormalities. Hence patients presenting with these symptoms are best evaluated with anorectal physiology testing and dynamic imaging. Nonoperative approaches include pelvic floor physical therapy, biofeedback therapy, and vaginal pessaries. Various operative approaches exist, each with different targets and measurements of successful repair.
Effect of the length of the second stage of labor on pelvic floor dysfunction
2023, American Journal of Obstetrics and Gynecology MFM
Pelvic floor dysfunction refers to any combination of incontinence, overactive bladder, pelvic organ prolapse, and sexual dysfunction. Pelvic floor dysfunction affects approximately 25% to 30% of women and is linked to parity and age. Some obstetrical risk factors have been highlighted, though the second stage of labor has not been as thoroughly investigated. Allowing a longer second stage has been suggested as a method of reducing the rates of cesarean delivery in nulliparous women, though it has also been linked to pelvic floor injuries.
This study aimed to determine the effect of the length of the second stage of labor on self-reported pelvic floor dysfunction.
This was a single-center prospective cohort study in a tertiary referral obstetrical unit. Nulliparous women attending routine antenatal clinics were recruited to complete the Australian Pelvic Floor Questionnaire during pregnancy and again 3 months after delivery. The primary outcome in this study was the effect of the length of the second stage of labor on total pelvic floor scores when analyzed using multiple regression. The models were adjusted for the mother's age, mother's body mass index, length of the second stage of labor, fetal birthweight, mode of delivery, and perineal trauma. The secondary outcomes included the comparison of maternal, obstetrical, and functional pelvic floor outcomes based on the mode of delivery and the length of the second stage of labor.
Among the 295 women who were recruited, the length of the second stage of labor and body mass index were associated with self-reported bladder dysfunction on multiple regression, whereas maternal age was protective. Compared with those with 60 to 120 minutes or <60 minutes of second stage of labor, women with that longer than 120 minutes had higher rates of stress incontinence (85.7% [>120 minutes] vs 41.7% [60–120 minutes] or 52.5% [<60 minutes], P=.001), urinary urgency (89.3% [>120 minutes] vs 39.6% [60–120 minutes] or 53.8% [<60 minutes], P<.001), and fecal incontinence (10.7% [>120 minutes] vs 0% [60–120 minutes] or 1.2% [<60 minutes], P=.027). There were no differences in the rates of sexual activity or dyspareunia. Women delivering vaginally had higher rates of stress incontinence (57.6% vs 38.0%, P=.006) than those undergoing cesarean delivery, though there were no differences in other pelvic floor symptoms or pelvic floor scores.
A prolonged second stage of labor is associated with more self-reported bladder dysfunction at 3 months postnatal in primiparous women. Women with a longer second stage of labor should be informed about the risk of short-term bladder dysfunction, though the prevalence of long-term sequelae is unknown.
Bulging of the bladder and vagina, with difficulty urinating: Prolapse of pelvic organs due to a weak pelvic floor, with associated urinary and rectal dysfunction
2023, Symptomatic: The Symptom-Based Handbook for Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders
Connective tissue plays an important structural role in the urogenital organs and the pelvic floor. In Ehlers-Danlos syndromes (EDS), complications are seen in the bladder, uterus, vaginal wall, colorectal tissues, and pelvic ligaments. Multiple concerns are reported with higher frequency than seen in the general population. These concerns include: menstrual complications; vulval pain; bladder and pelvic inflammation; and anterior and posterior prolapses, incontinence, and pelvic floor dysfunction. Males also experience pelvic floor dysfunction and rectal disorders. Musculoskeletal (MSK) concerns at the pelvic floor may be the cause or the consequence of issues above and/or below the pelvis, for example, compensating by bracing the pelvic floor. A holistic approach to assessment and treatment is needed. The reader is directed to chapters on bladder concerns and on abdominal pain due to abdominal vascular compression for a broader differential diagnosis.
Pelvic organ prolapse: a cross-sectional study during mass campaign in two hospitals in the city of Kananga in the Democratic Republic of Congo
2024, Pan African Medical Journal
Transvaginal mesh or grafts or native tissue repair for vaginal prolapse
2024, Cochrane Database of Systematic Reviews
Everything About Urogynecologic Surgery That I Thought Was True But Is Not
2024, Urogynecology

View all citing articles on Scopus

^☆: Supported by the National Heart, Lung, and Blood Institute, US Department of Health and Human Services.

View full text

Progression and remission of pelvic organ prolapse: A longitudinal study of menopausal women☆

Abstract

Objective

Study design

Results

Conclusion

Section snippets

Study population

Study population

Comment

Obstet Gynecol

Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol