Prevalence, risk factors, and predictors of pelvic organ prolapse

Abstract

Objective: This study aimed to determine the prevalence of pelvic organ prolapse (POP) in a village in East Lebanon and to evaluate related risk factors and clinical predictors.

Methods: Five hundred four ever-married women, aged 15 to 60 years, were interviewed and underwent physical and pelvic examinations and laboratory testing. Prolapse was determined according to a simplified version of the POP quantification system.

Results: Two hundred fifty-one (49.8%) women had clinically significant POP. When stratified by life decade, POP prevalence was 20.4% for women aged 20 to 29 years, 50.3% for women aged 30 to 39 years, 77.2% for women aged 40 to 49 years, and 74.6% for women aged 50 to 59 years, suggesting a plateau in prevalence in the decade after menopause. Clinically significant POP was found in 3.6% of nulliparous, 6.5% of primiparous, 22.7% of secondiparous, 32.9% of triparous, and 46.8% of tetraparous women. Increasing age, increasing vaginal parity, and a body mass index higher than 24 kg/m2 were found to be significant risk factors for POP, with relative risks of 1.09 (P < 0.001), 2.31 (P < 0.0001), and 1.62 (P = 0.048) respectively. Combined clinical symptoms of pelvic heaviness, urinary disturbances, and a feeling of bulge in the vagina were predictive of POP.

Conclusions: Our findings suggest that cost-efficient interventions to reduce the burden of POP in this and similar remote communities include the following: family planning awareness campaigns focusing on the risks of grand multiparity; nutritional education and weight management programs to help reduce the progression of POP before the age of menopause; and consideration of symptom-based screening to identify affected women who might benefit from a referral to specialty care at a tertiary care center.