Monday, October 12, 2009

What Else Can Lead to Pelvic Organ Prolapse Besides Childbirth?

It is widely known and accepted that even just one vaginal birth is the most common risk factor for pelvic organ prolapse (POP) such as cystocele, rectocele, uterine prolapse and urinary incontinence. There are some women who can develop POP even in the absence of vaginal birth. POP is usually blamed on torn or stretched connective tissue (fascia) that invests/supports the pelvic floor muscles (levator ani), in addition to injury to nerves r blood supply to the organs in question. Are there other concomitant conditions that may call attention to the risk of developing POP?

Interestingly, and per common sense, POP conditions and urinary incontinence often co-exist in women. A huge study from Kaiser in 2008 surveyed more than 4000 women, with a mean age of 56, to see what kind of pelvic floor disorders they have. The prevalence is as follows:

Stress Incontinence 15%
Overactive Bladder 13%
Pelvic Organ Prolapse 6%
Anal Incontinence 25%

Not surprisingly, 48-80% of women with one disorder reported having at least another disorder. 60% of women had at least something.
An even larger population based study of women from Stockholm of 8000 recently reported their findings of the non-obstetric risks for developing POP. They are:

Age
Obesity
History of conditions suggesting connective tissue defects (hernia, varicose veins, hemmorhoids)
Family history of POP
Heavy lifting at work
Constipation

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