Pelvic organ prolapse is a common condition that can lead to genital tract dysfunction and diminished quality of life. Signs include descent of one or more of the following: the anterior vaginal wall, posterior vaginal wall, uterus and cervix, vaginal apex, or the perineum (Haylen, 2010). Symptoms include vaginal bulging, pelvic pressure, and splinting or digitation. Splinting is manual bolstering of the prolapse to improve symptoms, whereas digitation aids stool evacuation. For pelvic organ prolapse to be considered a disease state in a given individual, symptoms should be attributable to pelvic organ descent such that surgical or nonsurgical reduction relieves the symptoms, restores function, and improves quality of life.
Pelvic organ prolapse (POP) affects millions of women worldwide. In the United States, it is the third most common indication for hysterectomy. Moreover, a woman has an estimated cumulative lifetime risk of 12 percent to undergo surgery for POP (Wu, 2014). Estimates of disease prevalence are hampered by lack of consistent definitions. If the validated Pelvic Organ Prolapse Quantification examination alone is used to describe pelvic organ support, 30 to 65 percent of women presenting for routine gynecologic care have stage 2 prolapse (Bland, 1999; Swift, 2000, 2005; Trowbridge, 2008). In contrast, studies that define prolapse solely based on patient symptoms show a prevalence ranging from 3 to 6 percent in the United States (Bradley, 2005; Nygaard, 2008; Rortveit, 2007).
Table 24-1 summarizes predisposing factors for POP. It develops gradually over a span of years, and its etiology is multifactorial. The relative importance, however, of each factor is not known.
TABLE 24-1Risk Factors Associated with Pelvic Organ Prolapse ||Download (.pdf) TABLE 24-1 Risk Factors Associated with Pelvic Organ Prolapse
|Vaginal childbirth |
| Aging |
| Hypoestrogenism |
|Chronically increased intraabdominal pressure |
| Chronic obstructive pulmonary disease |
| Constipation |
| Obesity |
|Pelvic floor trauma |
|Genetic factors |
| Race |
| Connective tissue disorders |
|Spina bifida |
Of these, vaginal childbirth is the most frequently cited risk factor. Some evidence suggests that pregnancy itself predisposes to POP. But numerous studies have clearly shown that vaginal delivery increases a woman’s propensity for developing POP. In the Pelvic Organ Support Study (POSST), increasing parity was associated with prolapse risk (Swift, 2005). Specifically, the risk of POP increased 1.2 times with each vaginal delivery. In the Reproductive Risks for Incontinence Study at Kaiser (RRISK) study, Rortveit and colleagues (2007) found that the prolapse risk increased significantly in woman with one vaginal delivery (odds ratio [OR] 2.8), two (OR 4.1), or three or more (OR 5.3) deliveries compared with nulliparas. In a longitudinal study of 1011 women, vaginal delivery was associated with a significantly greater risk of prolapse to the hymen ...