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INTRODUCTION

Pelvic organ prolapse (POP) is a common condition that can lead to urogenital 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 the sensation of a vaginal bulge, pelvic pressure, and pelvic organ descent. Some degree of POP is present in a large proportion of the female population (Swift, 2000). It is considered a disease state only if surgical or nonsurgical reduction relieves the symptoms, restores function, and improves quality of life.

EPIDEMIOLOGY

POP affects millions of women worldwide. In the United States, it is the third most frequent indication for hysterectomy, and in women older than 70 years, prolapse repair is the most common inpatient procedure (Oliphant, 2010). A woman has a 12- to 19-percent cumulative lifetime risk to undergo POP-corrective surgery (Smith, 2010; Wu, 2014). Considering most women with POP do not elect surgical treatment, these percentages underestimate its true prevalence. Disease estimates are also hampered by inconsistent definitions. If 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, with POP defined solely by patient symptoms, prevalence rates range from 3 to 6 percent in the United States (Bradley, 2005; Nygaard, 2008; Rortveit, 2007). As the population ages, the number of women with POP is expected to rise dramatically, with 9.2 million women predicted to be affected in 2050 (Wu, 2009).

RISK FACTORS

Obstetrics-Related Risks

Table 24-1 summarizes predisposing factors for POP. It usually develops gradually over a span of years, and its etiology is multifactorial. The relative importance, however, of each factor is unknown.

TABLE 24-1Risk Factors Associated with Pelvic Organ Prolapse

Vaginal childbirth is the risk factor most commonly associated with POP. Some evidence suggests that pregnancy itself predisposes to POP. However, in numerous studies, vaginal delivery is linked to a woman’s propensity for developing POP. In the Pelvic Organ Support Study (POSST), the risk of POP rose 1.2 times with each vaginal delivery (Swift, 2005). Compared with nulliparas, Rortveit and colleagues (2007) found that the prolapse risk grew significantly with rising parity in woman with one, two, or three or more vaginal deliveries. In a longitudinal study of 1011 women, vaginal ...

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