Materiały źródłowe

• #1 Pelvic organ prolapse in females: Epidemiology, risk factors, clinical manifestations, and management – UpToDate

  https://www.uptodate.com/contents/pelvic-organ-prolapse-in-women-epidemiology-risk-factors-clinical-manifestations-and-management

  Pelvic organ prolapse (POP), the herniation of the pelvic organs to or beyond the vaginal walls, is a common condition. Many individuals with prolapse experience symptoms that impact daily activities, sexual function, and exercise. The presence of POP can have a detrimental impact on body image and sexuality. Treatment of POP requires significant health care resources; the annual cost of ambulatory care of pelvic floor disorders in the United States from 2005 to 2006 was almost $300 million and surgical repair of prolapse was the most common inpatient procedure performed in women older than 70 years from 1979 to 2006. The health care impact of prolapse is likely to expand based upon estimates of an increasing prevalence in the growing population of older adult women. […] The epidemiology, risk factors, clinical manifestations, and general principles of management are reviewed here.

• #2 Understanding Pelvic Organ Prolapse: A Comprehensive Review of Etiology, Epidemiology, Comorbidities, and Evaluation

  https://www.mdpi.com/2563-6499/6/1/6

  Pelvic organ prolapse (POP) is a prevalent condition characterized by the descent of one or more pelvic organs, such as the bladder, uterus, or rectum, into the vaginal canal due to weakened pelvic floor support. […] Epidemiological data underscore its rising prevalence, particularly among older women, highlighting disparities across populations and risk factors such as parity and socioeconomic status. […] POP is a prevalent condition, particularly among older women, with estimates of lifetime risk ranging from 30% to 50%, and the prevalence of symptomatic prolapse ranges from 3% to 12%. […] The prevalence of POP varies across populations and is influenced by factors such as age, parity, ethnicity, and socioeconomic status. […] Age is a significant risk factor for POP, with prevalence increasing with advancing age, peaking in the postmenopausal years. […] Epidemiological studies have provided valuable insights into the prevalence and distribution of POP across populations, guiding targeted interventions to reduce its burden.

• #3 Epidemiology and outcome assessment of pelvic organ prolapse – PubMed

  https://pubmed.ncbi.nlm.nih.gov/24142054/

  The aim was to determine the incidence and prevalence of pelvic organ prolapse surgery and describe how outcomes are reported. […] Pelvic organ prolapse (POP) when defined by symptoms has a prevalence of 3-6% and up to 50% when based upon vaginal examination. Surgery for prolapse is performed twice as commonly as continence surgery and prevalence varies widely from 6 to 18%. The incidence of POP surgery ranges from 1.5 to 1.8 per 1,000 women years and peaks in women aged 60-69. […] Significant variation exists in the prevalence and incidence of pelvic organ prolapse surgery and how the outcomes are reported. Much of the variation may be improved by standardisation of definitions and outcomes of reporting on pelvic organ prolapse surgery.

• #4

  https://link.springer.com/article/10.1007/s00192-013-2169-9

  The aim was to determine the incidence and prevalence of pelvic organ prolapse surgery and describe how outcomes are reported. […] Pelvic organ prolapse (POP) when defined by symptoms has a prevalence of 36 % and up to 50 % when based upon vaginal examination. Surgery for prolapse is performed twice as commonly as continence surgery and prevalence varies widely from 6 to 18%. The incidence of POP surgery ranges from 1.5 to 1.8 per 1,000 women years and peaks in women aged 6069. […] Significant variation exists in the prevalence and incidence of pelvic organ prolapse surgery and how the outcomes are reported. Much of the variation may be improved by standardisation of definitions and outcomes of reporting on pelvic organ prolapse surgery.

• #5 Epidemiology and Etiology of Pelvic Organ Prolapse | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-40862-6_45

  Pelvic organ prolapse (POP) is a common condition with a prevalence increasing with age. The worldwide prevalence of POP has recently been reported to be around 9%. There is, however, a great difference if the diagnosis is based on clinical evaluation or on symptoms or complaints: in the first case, the prevalence ranges from 41% to 56% whereas in the latter form 3% to 7%. Moreover racial differences have been observed; in a study carried out in the United States, the prevalence of POP was lower in African American women 1.9% as compared to Caucasian women 2.8% and Hispanic women 5.1%. Other risk factors or pathophysiological mechanisms have been reported such as familiar or genetic, obstetric, age and hormonal status, socioeconomic, general medical conditions, and previous pelvic surgery. In this chapter we will illustrate the actual evidence related to the abovementioned epidemiological data as well as the risk factors and pathophysiological mechanisms involved in POP.

• #6 Pelvic Organ Prolapse | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0501/p1111.html

  Pelvic organ prolapse, or genital prolapse, is the descent of one or more of the pelvic structures (bladder, uterus, vagina) from the normal anatomic location toward or through the vaginal opening. Women of all ages may be affected, although pelvic organ prolapse is more common in older women. The prevalence of pelvic organ prolapse varies widely across studies, depending on the population studied and entry criteria. Women of all ages may be affected, although it is more common in older women. In the Women’s Health Initiative study, investigators found a 41.1 percent prevalence of pelvic organ prolapse at a standard physical assessment in postmenopausal women older than 60 years who had not had a hysterectomy. […] The cause of pelvic organ prolapse is multi-factorial, resulting from loss of the support maintained by a complex interaction among the levator ani, the vagina, and the connective tissue, as well as neurologic injury from stretching of the pudendal nerves that may occur during childbirth.

• #6 Pelvic Organ Prolapse | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0501/p1111.html

  Most patients with pelvic organ prolapse are asymptomatic. A sense of bulging or protrusion in the vagina is the most specific symptom. Evaluation includes a systematic pelvic examination. Management options for women with symptomatic prolapse include observation, pelvic floor muscle training, mechanical support (pessaries), and surgery. Pessary use should be considered before surgery in women who have symptomatic prolapse. Most women can be fitted with a pessary regardless of the stage or site of predominant prolapse. Surgical procedures are obliterative or reconstructive.

• #7 Uterine Prolapse: Background, History of the Procedure, Problem

  https://emedicine.medscape.com/article/797295-overview

  The exact prevalence of POP is difficult to determine. However, it is estimated that the lifetime risk of requiring at least 1 operation to correct incontinence or prolapse is approximately 11%. […] Swift et al found that more than 50% of asymptomatic women presenting for annual gynecologic examination have at least stage 2 prolapse on examination. […] POP symptoms are most common in women aged 70-79 years.

• #8 Epidemiology of Pelvic Organ Prolapse and Urinary Incontinence | Abdominal Key

  https://abdominalkey.com/epidemiology-of-pelvic-organ-prolapse-and-urinary-incontinence/

  Epidemiology of Pelvic Organ Prolapse and Urinary Incontinence Steven E. Swift INTRODUCTION The epidemiology of urinary incontinence and pelvic organ prolapse are often included together in the literature; however, these two diseases are distinct and separate entities that have only superficial similarities in their epidemiology. They are both common diseases, occurring in 5% to 30% of the population, and both can be managed surgically, often simultaneously. It has been reported that there is an incidence of 2.04 to 2.63 surgical procedures to correct prolapse or genuine stress incontinence per 1,000 women-years, with an increasing incidence as women age, and a lifetime risk of undergoing surgery for prolapse or incontinence of 5% to 11.1%. […] Despite these limitations, the literature in this area is growing and we are beginning to understand and appreciate the epidemiology of these disorders. This will eventually allow us to recommend prevention strategies.

• #8 Epidemiology of Pelvic Organ Prolapse and Urinary Incontinence | Abdominal Key

  https://abdominalkey.com/epidemiology-of-pelvic-organ-prolapse-and-urinary-incontinence/

  EPIDEMIOLOGY OF PELVIC ORGAN PROLAPSE Incidence of Pelvic Organ Support Defects Determining the difference between normal and abnormal pelvic organ prolapse is complicated, not only because we lack a validated definition, but also because there is a lack of knowledge regarding the distribution of pelvic organ support in the normal female population. […] Three of the four large studies to date had similar findings, with the majority of subjects examined having POPQ stage I or II exams and only 3% to 9% having stage III and IV exams. […] Etiology of Pelvic Organ Prolapse Increasing parity and advancing age are consistently identified as risk factors for the development of pelvic organ prolapse. […] Childbirth Vaginal delivery of a term infant has been postulated to be the most significant contributor to the subsequent development of pelvic organ prolapse.

• #8 Epidemiology of Pelvic Organ Prolapse and Urinary Incontinence | Abdominal Key

  https://abdominalkey.com/epidemiology-of-pelvic-organ-prolapse-and-urinary-incontinence/

  Age Another area where the literature is in agreement involves the increasing prevalence of pelvic organ prolapse in a population as it ages. […] Menopause The literature is consistent that the risk of pelvic organ prolapse increases with advancing age, but what role menopause and hormone replacement therapy have on pelvic organ prolapse is unknown. […] Previous Surgery to Correct Pelvic Organ Support Defects This may not be a fair addition to the etiologies of pelvic organ prolapse, as these subjects already have manifested pelvic organ support defects and have the underlying pathologic processes that lead to this disease. […] Hysterectomy The role of hysterectomy as a cause of subsequent development of pelvic organ prolapse is controversial, with no current consensus.

• #9 Global burden and trends of pelvic organ prolapse associated with aging women: An observational trend study from 1990 to 2019

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9521163/

  Worldwide, about 40% of women will experience pelvic organ prolapse (POP), and this proportion is expected to increase with the aging of the population. […] In 2019, the global ASIR and AS-DALYs for POP were 316.19 (95%UI: 259.84381.84) and 10.37 (95%UI: 5.7917.99) per 100,000 population, respectively. […] Over the past three decades, the incidence and DALY of POP have been decreasing from 1990 to 2019. However, POP remains a major health problem, especially among females in less developed countries. […] The aging process has always been the main risk factor for the development of age-related diseases. […] It is reported that the proportion of women aged 7079 seeking medical consultation due to symptomatic POP is the highest, as high as 18.6/1,000. […] Given the aging population in the United States, the number of women suffering from POP is expected to increase by about 50% by 2050.

• #9 Global burden and trends of pelvic organ prolapse associated with aging women: An observational trend study from 1990 to 2019

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9521163/

  A study from the Gambia found that 46% of women had some degree of prolapse on examination, but only 12.5% of the women reported symptoms related to POP. […] Another study predicted that the total number of women who will undergo surgery for POP disorders will increase 48.1% by 2050 due to the aging population. […] In general, POP, as the most important factor affecting the health quality of elderly women, its incidence rate has attracted more and more attention, and taking necessary prevention and control strategies is the fundamental to truly improve the health quality of these women. […] The current research showed that the proportion of annual young incidences in all POP cases decreased year by year, while the proportion of elderly incidences cases increased, which is comparable with previous studies. […] Therefore, primary and secondary prevention measures of POP should be integrated into the practice of healthcare professionals dealing with aging women.

• #10

  https://journals.lww.com/greenjournal/abstract/1997/04000/epidemiology_of_surgically_managed_pelvic_organ.2.aspx

  To determine the incidence of surgically managed pelvic organ prolapse and urinary incontinence in a population-based cohort, and to describe their clinical characteristics. […] The age-specific incidence increased with advancing age. The lifetime risk of undergoing a single operation for prolapse or incontinence by age 80 was 11.1%. […] Pelvic floor dysfunction is a major health issue for older women, as shown by the 11.1% lifetime risk of undergoing a single operation for pelvic organ prolapse and urinary incontinence, as well as the large proportion of reoperations. […] Women have an 11.1% lifetime risk of surgical treatment for pelvic organ prolapse or urinary incontinence by age 80; reoperation is common.

• #11 “Epidemiology of Surgically Managed Pelvic Organ Prolapse and Urinary Incontinence” (1997), by Ambre L. Olsen, Virginia J. Smith, John O. Bergstrom, Joyce C. Colling, and Amanda L. Clark | Embryo Project Encyclopedia

  https://embryo.asu.edu/pages/epidemiology-surgically-managed-pelvic-organ-prolapse-and-urinary-incontinence-1997-ambre-l

  In 1997, physicians and researchers Ambre Olsen, Virginia Smith, John Bergstrom, Joyce Colling, and Amanda Clark published, Epidemiology of Surgically Managed Pelvic Organ Prolapse and Urinary Incontinence, in the journal Obstetrics and Gynecology. […] According to the authors, an estimated fifty percent of women who have previously given birth have had a prolapse. […] In their results section, the authors note that many women had repeat surgeries, suggesting a possible point of uncertainty in the pelvic organ prolapse grading scale. […] The authors found that the risk a woman had of undergoing at least one operation to treat those conditions over her lifetime was about eleven percent. […] The authors state that the difference in population characteristics between women affected by pelvic organ prolapse and urinary incontinence could suggest that the conditions have different causes.

• #11 “Epidemiology of Surgically Managed Pelvic Organ Prolapse and Urinary Incontinence” (1997), by Ambre L. Olsen, Virginia J. Smith, John O. Bergstrom, Joyce C. Colling, and Amanda L. Clark | Embryo Project Encyclopedia

  https://embryo.asu.edu/pages/epidemiology-surgically-managed-pelvic-organ-prolapse-and-urinary-incontinence-1997-ambre-l

  The authors explain that across both surgical treatments, many women had to have repeat surgeries for both, indicating a high rate of surgical failure. […] The authors state that other researchers should consider investigating the long-term effectiveness of surgery to treat pelvic floor disorders, such as pelvic organ prolapse and urinary incontinence. […] Olsen and colleagues article estimated the number of women treated for pelvic organ prolapse and urinary incontinence with surgery at the time of the articles publication, and worked to understand why some treatments failed.

• #12 Epidemiology, Risk Factors, and Social Impact of Pelvic Organ Prolapse | Abdominal Key

  https://abdominalkey.com/epidemiology-risk-factors-and-social-impact-of-pelvic-organ-prolapse/

  The incidence of prolapse requiring surgical correction after a hysterectomy is 3.6 per 1000 women-years, according to a large cohort study conducted by Mant and colleagues (1997) in the United Kingdom. The cumulative risk rises to 5% 15 years after hysterectomy. […] The etiologic features of POP are still poorly understood and multifactorial, attributable to a combination of risk factors and varying from patient to patient. […] Vaginal birth, advancing age, and an increased body mass index (BMI) or obesity are known to be the most consistent risk factors of developing uterogenital prolapse; however, numerous other factors contribute to this condition. […] The relative prevalence of POP rises approximately 40% with every decade of life. […] The association between a strong family history and prolapse, increased prevalence of hernias in patients with POP, racial differences in the prevalence of prolapse, and the increased prevalence in women with a connective tissue disorder (e.g., Marfan syndrome) make it very likely that genetic factors play an important role in the etiologic development of POP.

• #12 Epidemiology, Risk Factors, and Social Impact of Pelvic Organ Prolapse | Abdominal Key

  https://abdominalkey.com/epidemiology-risk-factors-and-social-impact-of-pelvic-organ-prolapse/

  Pelvic organ prolapse (POP) is a common problem affecting up to 50% of parous women; 6.3% of women will undergo a surgical correction for POP by 80 years of age. […] Epidemiologic studies of the natural history, incidence, and prevalence of POP are currently lacking. It is widely accepted that 50% of women will develop prolapse, but only 10% to 20% of those will seek evaluation for their condition. […] The annual incidence for POP surgery is reported to be between 1.5 and 1.8 cases per 1000 women-years with the incidence peaking in women between the ages of 60 and 69 years. […] In the United States, POP is thought to be the leading cause for more than 300,000 surgical procedures per year (22.7 per 10,000 women) with 25% undergoing subsequent surgical procedures at a total annual cost of more than 1 billion dollars.

• #13 Pelvic organ prolapse: clinical review | GPonline

  https://www.gponline.com/pelvic-organ-prolapse-clinical-review/womens-health/article/1433744

  Symptomatic pelvic organ prolapse is most common among hispanic American women and least common in African American women. […] The increased risk of pelvic organ prolapse in obese women is likely because of the effects of chronic increased pressure on the pelvic floor. […] The increased risk of pelvic organ prolapse in women who smoke is likely because of the chronic cough associated with smoking. […] Jobs involving heavy lifting have been associated with pelvic organ prolapse. […] There is a strong association between chronic constipation and pelvic organ prolapse. […] Evidence suggests a link between menopause and development of pelvic organ prolapse. […] There is evidence of an increased risk of prolapse in women with a first degree relative who has pelvic organ prolapse. […] Patients with joint hypermobility syndrome and connective tissue disorders, such as Ehlers-Danlos and Marfan syndromes, have a higher incidence of pelvic organ prolapse.

• #13 Pelvic organ prolapse: clinical review | GPonline

  https://www.gponline.com/pelvic-organ-prolapse-clinical-review/womens-health/article/1433744

  Pelvic organ prolapse refers to loss of support for the uterus, bladder or bowel, leading to prolapse of one or more of these compartments into the vagina. Prolapse can have a significant impact on the womans quality of life and body image. It is associated with disturbances to bowel, bladder and sexual function. […] It is estimated that up to 40% of women experience a degree of pelvic organ prolapse in their lifetime. The lifetime risk of undergoing prolapse surgery is 11% and up to 11% of patients will have a repeat operation within 11 years. It is likely that the number of women presenting with prolapse will increase. […] Risk factors for prolapse include the following. […] The risk of prolapse doubles with every decade of life. […] Pregnancy and childbirth are associated with pelvic organ prolapse. The incidence of prolapse is 50% in parous women and 2% in nulliparous women. The risk increases with the number of deliveries a woman has.

• #14 Frontiers | Global burden and trends of pelvic organ prolapse associated with aging women: An observational trend study from 1990 to 2019

  https://www.frontiersin.org/articles/10.3389/fpubh.2022.975829/full

  Global burden and trends of pelvic organ prolapse associated with aging women: An observational trend study from 1990 to 2019 […] Worldwide, about 40% of women will experience pelvic organ prolapse (POP), and this proportion is expected to increase with the aging of the population. […] In 2019, the global ASIR and AS-DALYs for POP were 316.19 (95%UI: 259.84–381.84) and 10.37 (95%UI: 5.79–17.99) per 100,000 population, respectively. […] Over the past three decades, the incidence and DALY of POP have been decreasing from 1990 to 2019. […] According to existing studies, the reported prevalence of POP varies widely, ranging from 3 to 50%. […] As with most non-communicable diseases, a better understanding of the epidemiology of pelvic floor dysfunction may help to improve the effectiveness of prevention and treatment. […] The aging process has always been the main risk factor for the development of age-related diseases. […] The current research showed that the proportion of annual young incidences in all POP cases decreased year by year, while the proportion of elderly incidences cases increased. […] Therefore, primary and secondary prevention measures of POP should be integrated into the practice of healthcare professionals dealing with aging women.

• #15 LSHTM LSHTM Research Online

  https://researchonline.lshtm.ac.uk/17121/

  Epidemiology of pelvic organ prolapse in rural Gambia, West Africa. […] To investigate the prevalence of pelvic organ prolapse in rural Gambia. […] Out of 1067 women consenting to speculum examination 488 (46%) were found to have some degree of prolapse. […] In 152 women (14%) the prolapse was severe enough to warrant surgical intervention. […] Pelvic organ prolapse has a high prevalence in this first community-based study of prolapse in West Africa. […] Parity was confirmed to be the strongest risk factor followed by age and anaemia. […] Ethnic origin was a previously unknown risk factor suggesting possible genetic factors in the pathogenesis of prolapse.

• #16 Prevalence of pelvic organ prolapse in women, associated factors and impact on quality of life in rural Pakistan: population-based study | BMC Women’s Health | Full Text

  https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-020-00934-6

  Pelvic organ prolapse (POP) is a gynecological condition resulting from pelvic floor dysfunction in women. The objective of this study is to estimate the prevalence of pelvic organ prolapse associated factors, duration and impact on womens quality of life in rural Pakistan. Among the 5064 women interviewed (95.8% response rate), 521 women had clinically confirmed POP, a prevalence of 10.3% (95% CI 911%). Among women with POP 37.8% had grade III or IV prolapse. Pelvic organ prolapse is highly prevalent in rural Pakistan, impacts on womens everyday lives and remains mainly untreated. The prevalence of POP based on clinical examination of symptomatic women was found to be 10.3% (95% CI 911%) among women aged 15years or older. The only socio-demographic factors significantly associated with increased likelihood of POP were: increasing age (OR 1.05, CI 1.041.06) and higher parity (OR 1.18, 95% CI 1.151.21). Among the women with POP, duration was long, with 44.3% reporting having had it for more than 5years. In terms of their overall quality of life, 60.8% reported a moderate or great impact, while 47.8% reported that it moderately or greatly impacted their everyday life, including hygiene, home/work life and social life. Overall more than 60% of women reported symptoms as greatly or moderately impacting their overall quality of life and almost half reported that their everyday life activities were also affected greatly or moderately. This large population-based study with high response rate and robust sampling and data collection methods has shown that POP was highly prevalent in a Pakistan rural population.

• #17 Epidemiology, Pathophysiology, and Evaluation of Pelvic Organ Support | Obgyn Key

  https://obgynkey.com/epidemiology-pathophysiology-and-evaluation-of-pelvic-organ-support/

  There are multiple risk factors for pelvic organ prolapse, defined as being definite, probable, or hypothesized. […] The role of advancing age in the increased occurrence of pelvic organ prolapse is obvious. […] Of the pelvic floor disorders, pelvic organ prolapse is the one that is most strongly associated with vaginal delivery. […] Several factors that can be grouped together as descriptors of difficult vaginal delivery are associated with increased occurrence of prolapse: forceps delivery, prolonged second stage of labor, and large infant birth weight have been associated with pelvic organ prolapse. […] Although there are incontrovertible data concerning the relationship between advancing age and vaginal delivery in causing pelvic organ prolapse, there are a number of factors that have supportive evidence indicating their relationship to increased risk for developing pelvic organ prolapse but for which data are less well established. […] There is evidence that chronic or significant increases in abdominal pressure may be related to increased occurrence of prolapse. […] Prolapse seems to also occur more often in some families than others.

• #17 Epidemiology, Pathophysiology, and Evaluation of Pelvic Organ Support | Obgyn Key

  https://obgynkey.com/epidemiology-pathophysiology-and-evaluation-of-pelvic-organ-support/

  Epidemiology, Pathophysiology, and Evaluation of Pelvic Organ Support John O. L. DeLancey Pelvic organ prolapse is a condition that has been known to affect women since the earliest medical records 4,500 years ago. […] Pelvic organ prolapse is the pelvic floor disorder that most often requires surgery, followed by surgeries for stress incontinence and fecal incontinence. Based on national hospital discharge data, it is known that approximately 200,000 American women undergo procedures for pelvic organ prolapse, while 80,000 operations per year are done for stress urinary incontinence and approximately 2,000 are for fecal incontinence. […] The annual direct cost of treating pelvic organ prolapse is slightly in excess of $1 billion annually. […] Because of the increase in pelvic organ prolapse at advancing age, it is expected that the demand for services related to pelvic floor disorders can be expected to double in the next decades, justifying the need for all obstetrician and gynecologists to be experienced in its diagnosis and management.

• #18 The Epidemiology, Natural History and Prevention of Pelvic Floor Disorders | GLOWM

  https://beta.glowm.com/section-view/heading/The-Epidemiology-Natural-History-and-Prevention-of-Pelvic-Floor-Disorders/item/825

  Pelvic organ prolapse (POP) refers to loss of support for uterus, bladder, colon or rectum leading to prolapse of one or more of these organs into the vagina. Prolapse is thus a continuous condition when measured by visual inspection of the vaginal wall during valsalva. For clinical purposes, the degree of POP is commonly described as above the introitus, at the introitus, or beyond the introitus with or without valsalva. Determining POP based on self-reported symptoms is difficult because of the lack of specificity and sensitivity of most symptoms attributed to POP and the fact that prolapse above the level of the hymeneal ring is usually asymptomatic. […] However, assessments of the prevalence of symptomatic pelvic organ prolapse (sPOP) in women are remarkably consistent with a prevalence between 4% and 11%. POP is a rare condition in nulliparous women and in women after one or several cesarean sections indicating that mode of delivery is more important than pregnancy alone. Vaginal delivery is associated with an increased risk of POP and increasing number of births is positively associated with increased risk of POP. There is increasing evidence to suggest that cesarean section is protective for POP.

• #18 The Epidemiology, Natural History and Prevention of Pelvic Floor Disorders | GLOWM

  https://beta.glowm.com/section-view/heading/The-Epidemiology-Natural-History-and-Prevention-of-Pelvic-Floor-Disorders/item/825

  Several risk factors for POP have been identified. Childbirth is associated with an increased risk of pelvic organ prolapse later in life and an increasing number of childbirths is positively associated with the risk. Current evidence also suggests that some surgical procedures, e.g. hysterectomy, increase the risk of subsequent pelvic organ prolapse. A number of somatic diseases and conditions have been linked to the occurrence of prolapse but the cause-effect relationship is undetermined. Life style factors and socioeconomic indices may be associated with the risk of POP in both industrialized and non-industrialized countries. The main risk factor for POP is vaginal delivery. Several other obstetric interventions and events have been associated with POP. […] Recently, cesarean section has been shown to provide partial protection for POP and to a lesser degree urinary incontinence. Regarding POP, exclusive cesarean section is associated with a reduced risk of objectively measured signs of prolapse 12 years after delivery and symptoms of prolapse 20 years after delivery. There is also a significant increase in prolapse surgery with vaginal delivery in comparison to cesarean section and a dramatically increased risk with forceps in comparison to a cesarean delivery.

• #19 Prevalence and characterization of pelvic organ prolapse in women from Quindío, Colombia. 2016-2019

  http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-00112022000300200

  POP is highly prevalent in Quindo women, with the majority of cases being multicomparment POP. This is a common condition in women over 50 years of age, and grand multiparas had a greater risk of POP. These data confirm that POP is a common health problem in this region of the country. […] Pelvic organ prolapse (POP) is a condition in which one or more pelvic organs, including bladder (anterior wall), uterus (apex), vaginal vault, and rectum (posterior wall) bulge into the vagina and towards the perineum or anal canal. This is a common condition with an increasing prevalence due to the aging population, affecting approximately 30% of women aged 20 to 59 and more than half of women over 50. […] The reported prevalence of POP varies greatly, and several studies indicate a range of 3% to 50%. In a literature review, Davis Kumar reported that nearly 50% of parous women lose pelvic floor support, resulting in some degree of POP.

• #20 Family history and acquired risk factors for pelvic organ prolapse: a case–control study in Japan | Scientific Reports

  https://www.nature.com/articles/s41598-025-90202-0

  This casecontrol study aimed to investigate the association between family history of pelvic organ prolapse (POP) and its development, combined with known clinical risk factors, in Japanese women. […] Multivariable logistic regression analysis revealed that the POP group had a significantly higher odds ratio for family history of POP (3.06 [1.098.56]; p=0.03), body mass index (BMI) (1.12 [1.031.22]; p=0.01), and parity (1.51 [1.201.89]; p=0.001). […] This suggests that family history of POP combined with BMI and parity may be useful predictors for POP development in Japanese women. […] The etiology of POP is likely multifactorial, including mainly acquired risk factors, such as aging, parity, and obesity. […] Epidemiological studies on POP are more frequently reported from Europe than from Asia; thus, a national survey on risk factors for POP, taking into account differences in race and lifestyle, is needed.

• #20 Family history and acquired risk factors for pelvic organ prolapse: a case–control study in Japan | Scientific Reports

  https://www.nature.com/articles/s41598-025-90202-0

  The key findings of this casecontrol study were as follows. First, a family history of POP, including within the third-degree relatives, was more frequent in the POP group, which is a novel finding in the Japanese population. […] To the best of our knowledge, this is the first report within a Japanese population, which underscores the importance of our findings. […] Thus, our recent study linked POP occurrence in Japanese women with SNPs in LOXL4 (odds ratio, 3.84.5), an enzyme involved in collagen and elastin fiber maturation, which is essential for extracellular matrix remodeling. […] Therefore, prediction based on distinct family history and acquired risk factors such as this study might be useful to prevent the development of advanced POP.

• #21 Risk Factors and Severity Indicators of Female Pelvic Organ Prolapse: Insights from a Comprehensive Retrospective Study with a Large Sample Size

  https://www.imrpress.com/journal/CEOG/51/12/10.31083/j.ceog5112280

  Pelvic organ prolapse (POP) is a common condition worldwide, predominantly affecting middle-aged and elderly postmenopausal women. […] This study aimed to analyze the distribution of POP severity stages, identify associated risk factors, and explore its underlying pathogenesis to develop strategies for early prevention and intervention. […] Among 9569 patients with anterior vaginal wall prolapse, the severity was distributed as follows: grade I (38.52%), grade II (60.70%), grade III (0.77%), and grade IV (0.01%). […] Multivariate logistic regression analysis identified several significant risk factors associated with the progression of anterior vaginal wall prolapse, including advanced maternal age (AMA) (≥35 years), body mass index (BMI) (≥25 kg/m²), parity (≥2), and vaginal delivery (p < 0.05).

• #22 Genetic epidemiology of pelvic organ prolapse: a systematic review. | Center for Women’s Health Research

  https://www.vumc.org/whr/publication/genetic-epidemiology-pelvic-organ-prolapse-systematic-review

  Given current evidence supporting a genetic predisposition for pelvic organ prolapse, we conducted a systematic review of published literature on the genetic epidemiology of pelvic organ prolapse. […] The metaanalysis suggests that collagen type 3 alpha 1 (COL3A1) rs1800255 genotype AA is associated with pelvic organ prolapse (odds ratio, 4.79; 95% confidence interval, 1.91-11.98; P = .001) compared with the reference genotype GG in populations of Asian and Dutch women. […] There was insufficient evidence to determine whether other single nucleotide polymorphisms evaluated by 2 or more papers were associated with pelvic organ prolapse. […] An association with pelvic organ prolapse was seen in individual studies for estrogen receptor alpha (ER-) rs2228480 GA, COL3A1 exon 31, chromosome 9q21 (heterogeneity logarithm of the odds score 3.41) as well as 6 single nucleotide polymorphisms identified by a genome-wide association study.

• #23 SciELO Brazil – Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse

  https://www.scielo.br/j/ibju/a/mHJtzHfncRm5ZXQV3zKPbmG/?lang=en

  However, the causes for weakening of the connective tissue and pelvic floor ligaments is still unclear and answers may be found while looking closer at the risk factors. […] It is evident that there is a strong genetic basis for POP. […] A hypoestrogenic environment especially in post-menopausal women has a significant role in the development of POP.

• #23 SciELO Brazil – Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse

  https://www.scielo.br/j/ibju/a/mHJtzHfncRm5ZXQV3zKPbmG/?lang=en

  Other studies that give insight regarding the prevalence of POP are those reporting data on patients who have undergone POP reconstruction surgeries. […] As with those who seek medical care and consultation, the prevalence and incidence of POP reconstructive surgery also increases with age. […] Another important epidemiological indicator is the rate of recurrent POP and the need for recurrent surgery. […] There is approximately a 30% recurrent prolapse rate following POP repair surgery. […] The current understanding of the pelvic floor is based on the work of two modern anatomists: Peter Petros and John Delancey. […] The Integral Theory represents the foundation of our current knowledge of the development of POP. […] The understanding that the pelvic floor relies on the pelvic floor fascia and ligaments for its support enables us to identify the specific injury causing the prolapse and to treat it accordingly.

• #23 SciELO Brazil – Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse

  https://www.scielo.br/j/ibju/a/mHJtzHfncRm5ZXQV3zKPbmG/?lang=en

  The exact prevalence of pelvic organ prolapse is difficult to establish. […] The currently available demographic data is not reliable enough to properly estimate the true extent of pelvic organ prolapse in the population. However, standardization of the diagnosis and treatment may significantly improve our ability to estimate the true incidence and prevalence of this condition in the coming years. […] The reported prevalence of POP is highly varied according to different studies and is found to be anywhere between 3% and 50%. […] Among women having symptomatic POP, the age distribution increases dramatically. […] With increased longevity and an increase in the demographic of women over 65 years, it is expected that in the near future POP will become a major health concern. […] The average age of women seeking medical consultation for symptomatic POP is 61.

• #24 Pelvic organ prolapse – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pelvic-organ-prolapse/symptoms-causes/syc-20360557

  Pelvic organ prolapse is when one or more pelvic organs drop from their position. This makes a bulge in the vagina, called a prolapse. […] Pelvic organ prolapse happens when the muscles and tissues of the pelvic floor weaken. This may be due to pregnancy, childbirth or menopause. […] The cause of pelvic organ prolapse is the weakening of the tissues and the muscles that support the pelvic organs. The most common cause is having a baby vaginally. […] Risk factors for pelvic organ prolapse include: Having more than one baby, vaginal delivery, high birth weight babies and deliveries using tools. Being older. Being obese. Having had pelvic surgery. Straining from an ongoing cough, such as from chronic obstructive pulmonary disease, ongoing constipation or ongoing heavy lifting. Having a family history of pelvic organ prolapse or connective tissue conditions.

• #25 Exploring risk factors of pelvic organ prolapse at eastern of Democratic Republic of Congo: a case-control study | BMC Women’s Health | Full Text

  https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-024-03010-5

  The study aimed to determine the risk factors associated with pelvic organ prolapse. The analysis showed that POP was associated with low BMI, having given birth at least twice at home, having a family history of prolapse, previous birth without an episiotomy, a height150 cm and vaginal birth of a macrosomic baby. […] A significant proportion of patients in the study area have pelvic organ prolapse. There are several demographic and obstetric variables, including low BMI, a height equal to or less than 150 cm, home birth, family history of prolapse, history of birth without an episiotomy and previous delivery of a macrosomic baby, that were significantly associated with prolapse in our study cohort.

• #26 Epidemiology and psychosocial impact of female pelvic floor disorders | Obgyn Key

  https://obgynkey.com/epidemiology-and-psychosocial-impact-of-female-pelvic-floor-disorders-2/

  Most population-based surveys define prolapse based solely on patient symptoms, commonly defined as an affirmative response to seeing/feeling a vaginal bulge. Using this definition, the prevalence of prolapse symptoms ranges from 2.9% to 8% in the United States. […] Additional studies from the Womens Health Initiative (WHI) including US women aged 50 to 79 years found the prevalence of any degree of prolapse based on examination alone of grades 1 to 3 prolapse to be 41.1%. […] Data are limited for the incidence and remission of pelvic organ prolapse. Based on the WHI data, the incidence of grades 1 to 3 prolapse is estimated to be 9.3/100 woman-years for cystocele, 5.7/100 woman-years for rectocele, and 1.5/100 woman-years for uterine prolapse. […] The remission rates are estimated to be up to 9%, with cystocele having higher remission rates than rectocele. Prolapse progression ranged from 1.9% for uterine prolapse, to 9.5% for cystocele, and 14% for rectocele. Older, parous women are more likely to develop new or progressive prolapse than to regress.

• #26 Epidemiology and psychosocial impact of female pelvic floor disorders | Obgyn Key

  https://obgynkey.com/epidemiology-and-psychosocial-impact-of-female-pelvic-floor-disorders-2/

  After pregnancy and delivery, 31% of women have stage 2 prolapse. […] There are limited cost analysis data available for pelvic organ prolapse. In 1997, the direct cost of pelvic organ prolapse surgery was estimated to be $1.0 billion based on national average Medicare reimbursement. […] It is predicted that the annual economic cost of pelvic organ prolapse surgeries will grow at twice the rate of population growth because of aging populations in the United States and Europe over the next decades.

• #27 Pelvic Organ Prolapse | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0801/p179.html

  Pelvic organ prolapse is the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus (cervix), or the apex of the vagina (vaginal vault or cuff scar after hysterectomy). Prevalence increases with age. […] Although pelvic organ prolapse can affect women of all ages, it more commonly occurs in older women. The prevalence of pelvic organ prolapse increases with age until a peak of 5% in 60- to 69-year-old women. […] The number of women who have pelvic organ prolapse is expected to increase by 46%, to 4.9 million, by 2050. […] Limited data suggest that prolapse progresses until menopause, with low rates of progression and regression thereafter.

• #28 Pelvic Organ Prolapse: Practice Essentials, Background, Problem

  https://emedicine.medscape.com/article/276259-overview

  The exact prevalence of pelvic organ prolapse is difficult to determine. However, the lifetime risk of requiring at least 1 operation to correct incontinence or prolapse is estimated at approximately 11%. […] About 200,000 inpatient procedures are performed annually in the United States. […] Symptoms of pelvic organ prolapse occur most frequently in women aged 70-79 years.

• #29 Pelvic organ prolapse: a cross-sectional study during mass campaign in two hospitals in the city of Kananga in the Democratic Republic of Congo

  https://www.panafrican-med-journal.com//content/article/47/52/full

  Pelvic organ prolapse is a dynamic pathology that can worsen or regress especially postpartum and is the basis of several disorders that bother the patient and alter her quality of life. This study aims to determine the epidemiological, clinical, and therapeutic profile of pelvic organ prolapse in the town of Kananga. […] The prevalence of pelvic organ prolapse is 24.12% with an average monthly incidence of 19.71 (SD: 4.23) cases per month. The prevalence of recurrence of pelvic organ prolapse is 8.69%. […] Pelvic organ prolapse is a real public health problem in the city of Kananga, its symptoms are classic and its treatment is surgical via the vaginal route. […] The prevalence of pelvic organ prolapse is 24.12% with its recurrences of 8.69%. Its preoperative symptomatology consists of the vaginal mass associated with digestive and urinary disorders, stage III hysterocele predominates, surgical treatment is the most practiced and hysterectomy associated with the treatment of cystocele and rectocele by surgical access vaginal is the most practiced.

• #30 The epidemiology of urinary complaints in women with pelvic organ prolapse: a five-year review – Pelviperineology A Multidisciplinary Pelvic Floor Journal

  https://pelviperineology.org/articles/the-epidemiology-of-urinary-complaints-in-women-with-pelvic-organ-prolapse-a-five-year-review/doi/36923

  The relationship between Pelvic Organ Prolapse (POP) and Lower Urinary Tract Symptoms (LUTS) remains unclear. Our aim was to update evidence on the prevalence of LUTS in patients with POP. […] 7 cross-sectional studies and 15 surgical series of prolapse repair reported on the prevalence LUTS. […] Stress Urinary Incontinence (SUI) is the most commonly assessed symptom with a prevalence ranging from 25 to 64% in surgical series and from 40 to 56% in epidemiologic studies. […] The prevalence of occult SUI, demonstrable only after prolapse reduction, is reported to be as high as 35.8%. […] Voiding symptoms are also prevalent particularly in patients with advanced prolapse. […] Overactive bladder (OAB) affects more than half of women with prolapse. […] Lower urinary tract symptoms are common in women with pelvic organ prolapse. The exact pathophysiology of the symptoms remains to be elucidated.

• #31

  https://journals.lww.com/co-urology/fulltext/2013/07000/epidemiology_and_prevalence_of_pelvic_organ.2.aspx

  The purpose of this review is to discuss the epidemiology and prevalence of pelvic organ prolapse. […] As the elderly population is expected to double in number by the year 2030, pelvic organ prolapse will become more prevalent. […] To allocate resources to the increasing number of female patients who will present to healthcare providers with pelvic organ prolapse, we need a better understanding of its incidence, risk factors, prevalence, natural history, clinical implications, and treatment options. This understanding will not only improve our ability to treat this growing patient population but will also help us develop preventive strategies to ameliorate patients suffering from this condition.

• #32 Classification and Epidemiology of Pelvic Organ Prolapse | 89 | v5 | T

  https://www.taylorfrancis.com/chapters/edit/10.1201/9781003144243-89/classification-epidemiology-pelvic-organ-prolapse-steven-swift-joel-winer

  The study of pelvic organ prolapse is one area of medicine that seems so intuitive but in actuality this intuition makes it harder to form firm and scientifically validated definitions. The current Pelvic Organ Prolapse Quantification (POPQ) classification system may be able to accurately and reproducibly codify pelvic organ support but it does not classify the aforementioned support into normal versus abnormal. It has proven itself to be a reliable system, and it is the system that should be employed in research regarding pelvic organ support. Since POPQ is now the widely accepted method for describing pelvic organ support in research and academic work in urogynecology, it is important for the practitioner to become familiar with its use. […] In response to concerns regarding the clinical utility of the POPQ, the IUGA set up a task force to develop a more user-friendly system for classifying pelvic organ support.

• #33 Pelvic organ prolapse – a review

  https://www.racgp.org.au/afp/2015/july/pelvic-organ-prolapse-a-review

  FPOP is a common condition and has a lifetime risk for surgery of 10-20%. The aetiology is not fully understood; however, congenital factors play a role, and lifestyle factors such as obesity and smoking may contribute. Pregnancy and childbirth, especially vaginal delivery, are the most common modifiable risk factors, particularly for bladder and uterine prolapse, which are partly mediated through levator trauma. Use of forceps is the main modifiable obstetric risk factor. […] Vaginal childbirth is the main aetiological factor for FPOP. The largest potential hernial portal in the human body, the levator hiatus, is also the most critical soft tissue impediment to vaginal childbirth. […] The use of forceps, the primary risk factor for levator avulsion, is entirely avoided in some countries and institutions, demonstrating that this risk factor is eminently modifiable. Odds ratios for levator avulsion in forceps relative to vacuum are 3.4-11.4, suggesting a large potential for prevention of pelvic floor trauma and FPOP, with the added benefit of less anal sphincter tears and anal incontinence. […] FPOP is a common condition requiring surgery in 10-20% of women. Vaginal childbirth is the main aetiological factor, and major tears of the levator ani muscle (avulsion) seem to be the primary link between childbirth and prolapse of the bladder and uterus.

• #34 Uterine prolapse and associated factors among reproductive-age women in south-west Ethiopia: A community-based cross-sectional study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0262077

  Uterine prolapse is an important but neglected public health problem that causes maternal morbidity and mortality in women of reproductive age in low- and middle-income countries, including Ethiopia. […] The worldwide prevalence of UP has been reported to be around 9%. However, in low and middle-income countries (LMICs), it is estimated to be nearly 20%, and estimates vary widely (3.4-56.4%). […] Major risk factors associated with UP are adolescent pregnancy, lack of rest during and immediately after pregnancy, carrying heavy loads, delivery by unskilled birth attendants, poor nutrition, frequent pregnancies and pregnancies close together, prolonged and obstructed labor, and weakening of pelvic muscles as a result of aging or other medical problems. […] UP is, therefore, an important but one of the most neglected public health problems in LMICs, including Ethiopia, where there is little literature regarding its prevalence.

• #35 Genital prolapse: epidemiology, clinic and therapeutic at Saint Joseph Hospital of Kinshasa

  https://www.panafrican-med-journal.com/content/article/37/196/full/

  The aim of the study was to describe the epidemiological, clinical and therapeutical profile of genital prolapse in the Gynecology and Obstetrics Service of Saint Joseph Hospital of Kinshasa. […] We recorded 161 cases of genital prolapses upon 13957 patients. The genital prolapses frequency was 1.2% with an annual average of 16.1 cases (SD 10.1) per year. […] The prevalence of genital prolapse varies from 2.9% to 97.7% in the world according to the method used for the study. […] In the Democratic Republic of Congo, this prevalence is not known and data to estimate its incidence are inexistent. […] The frequency of genital prolapses was of 1.2% at SJH. […] The high frequency observed in 2017 was linked to the first public awareness campaign for the free treatment of genital prolapses at SJH.

• #36 Neglect of pelvic organ prolapse and urinary incontinence are exemplary of human rights violations towards women: moving towards a resolution | Figo

  https://www.figo.org/resources/figo-statements/neglect-pelvic-organ-prolapse-urinary-incontinence-exemplary-human-rights-violations

  Pelvic organ prolapse (POP) and female urinary incontinence (UI) extend beyond physical discomfort and highlight health disparities facing women globally. […] Although estimates of POP prevalence differ by country and method of diagnosis, it is estimated that globally up to 50% of women will experience POP in their lifetimes, with 11.1% of women undergoing prolapse surgery in high-income countries. […] The World Health Organization (WHO) emphasises that achieving health for all is a fundamental human right. […] Resource inequities including access to trained professionals and adequate health care infrastructure for both prevention and management continue to be a barrier. […] Female UI and POP are not mere health conditions of women to be referred to a urogynaecologist. They are a significant part of the post-reproductive morbidity of women. […] These violations perpetuate shame, inequality and disparities in health care access, particularly in LMICs. […] Targeted public health campaigns and educational programmes can challenge cultural stigmas and raise awareness about POP and UI in LMICs.

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