An epidemiologic study of pelvic organ prolapse in rural Chinese women: a population-based sample in China

Assessing the link between birth interval and pelvic organ prolapse severity in reproductive-age women in rural Turkey: A cross-sectional study on quality of life

OBJECTIVE

Pelvic organ prolapse (POP) impacts women's quality of life globally. We aimed to assess the association between the number of births, minimum birth intervals, and POP grade, and their relationship with quality of life in reproductive-aged women in rural Turkey.

METHODS

This cross-sectional study was conducted in rural Turkey from June to September 2024, involving women attending a rural state hospital's gynecology clinic. Participants were divided into group 1 (n = 96, POP stage 0-1) and group 2 (n = 96, POP stage 2-3-4), using Pelvic Organ Prolapse Quantification (POP-Q) system staging. Genital hiatus and perineal body measurements were recorded, and the Prolapse Quality of Life (P-QOL) questionnaire was administered. As outcome measures, we assessed the number of births, minimum birth intervals, genital hiatus, perineal body measurements, and sociodemographic factors, for their associations with POP-Q stage and quality of life.

RESULTS

Participants' mean age was 38.0 ± 7.4 years. Women in group 2 had more vaginal deliveries (4.4 ± 1.5 vs. 4.0 ± 1.5; P = 0.042), shorter minimum birth intervals (18.5 ± 7.9 vs. 25 ± 29.5 months; P = 0.004), higher birth weight of the heaviest child (3667.5 ± 540.6 vs. 3468.1 ± 523.3 g; P = 0.008), and larger genital hiatus (4.3 ± 0.9 vs. 3.5 ± 1.0 cm; P < 0.001). Group 2 had significantly higher P-QOL scores, indicating poorer quality of life. Receiver operating characteristic (ROC) curve analysis identified predictive thresholds for severe prolapse: six or more vaginal deliveries, genital hiatus diameter ≥5.25 cm, and heaviest child's birth weight ≥4250 g.

CONCLUSION

Increased number of vaginal births, higher birth weight of the heaviest baby, and shorter intervals between births are significantly associated with more severe POP stages.

Unveiling the depths of pelvic organ prolapse: From risk factors to therapeutic methods (Review)

Pelvic organ prolapse (POP) is a condition where one or more pelvic organs (such as the uterus, bladder and rectum) descend from their normal anatomical positions into the vagina, primarily due to the weakening of the pelvic floor support structures. While not life-threatening, POP can substantially diminish the patient's quality of life and lead to serious social and psychological complications. Researchers have explored novel directions regarding the etiology, mechanism and treatment of POP. However, existing literature on the subject often lacks comprehensive and systematic overviews. To address this gap and enhance researchers' understanding of POP, the present study reviewed the risk factors and molecular mechanisms of POP [including matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs, transforming growth factor β, advanced glycation end products (AGEs)/receptor for AGE, phosphoinositide 3-kinase/protein kinase B, fibulin, lysyl oxidase-like 1, homeobox A11, collagen α-1 (XVIII) chain, Wnt signaling pathways and estrogen receptor α], as well as therapeutic approaches, such as lifestyle interventions, physical methods, pharmacotherapy, stem cell transplantation and surgical techniques. The present review aims to provide new insights for future research and contribute to the advancement of diagnosis and treatment strategies for POP.

Outcomes of a novel modified total colpocleisis for advanced pelvic organ prolapse in elderly women and its efficacy on lower urinary tract symptoms

OBJECTIVES

To evaluate the effectiveness of modified total colpocleisis for advanced pelvic organ prolapse (POP) in elderly women and to assess the improvement in lower urinary tract symptoms (LUTS) of the patients.

METHODS

An observational cohort study was conducted, including 105 POP patients who underwent modified total colpocleisis between April 2020 and December 2022. The study analyzed the patients' demographic characteristics, perioperative outcomes, and follow-up outcomes, including complications, remission of LUTS, satisfaction rates, and regret rates. Confirming the safety, durability, and patient satisfaction of modified total colpocleisis.

RESULTS

Most patients (95/105, 90.5%) had more than one comorbidity. Eighty-six (81.9%) had a concomitant hysterectomy, the average operative time was 112.78 ± 34.92 min, with a median estimated bleeding of 50 mL (10-300 mL). Perioperative changes in hemoglobin and hematocrit were 11.64 ± 10.03 g/L and 3.87% ± 3.05%, respectively. Urinary retention was the most common complication (10/105, 9.5%). With a median follow up of 16 months (3-35 months), 101 patients (96.2%) reported satisfaction with the results of the procedure, with none reporting regret. Both subjective and anatomical recurrence rates were quite low (2.9% and 5.7%, respectively). Twenty-three (21.9%) had de novo urinary incontinence, and the remaining LUTS such as frequent, urgent, hesitation, and difficulty emptying were significantly improved (P < 0.05).

CONCLUSION

Modified total colpocleisis is an effective treatment option for elderly women with severe POP. This procedure can significantly improve several LUTS, and most de novo incontinence is mild and has a limited impact on patients' quality of life.

A comprehensive evaluation of spontaneous pelvic organ prolapse in rhesus macaques as an ideal model for the study of human pelvic organ prolapse

Pelvic organ prolapse (POP) seriously affects a woman's quality of life, and the treatment complications are severe. Although new surgical treatments are being developed, the host tissue responses and safety need to be evaluated in preclinical trials. However, there is a lack of suitable animal models, as most quadrupeds exhibit different structural and pathological changes. In this study, 72 elderly rhesus macaques (Macaca mulatta) were physically examined, and the incidence of spontaneous POP was similar to that in humans. The vaginal wall from five control monkeys and four monkeys with POP were selected for further analysis. Verhoeff-van Gieson staining showed that elastin content decreased significantly in monkeys with POP compared with control samples. Immunohistological staining revealed that the smooth muscle bundles in monkey POP appeared disorganized, and the number of large muscle bundles decreased significantly. The collagen I/III ratio in monkey POP also significantly decreased, as revealed by Sirius Red staining. These histological and biochemical changes in monkeys with POP were similar to those in humans with POP. Moreover, we generated a single-cell transcriptomic atlas of the prolapsed monkey vagina. Cross-species analysis between humans and monkeys revealed a comparable cellular composition. Notably, a differential gene expression analysis determined that dysregulation of the extracellular matrix and an immune disorder were the conserved molecular mechanisms. The interplay between fibroblasts and macrophages contributed to human and monkey POP. Overall, this study represents a comprehensive evaluation of spontaneous POP in rhesus macaques and demonstrates that monkeys are a suitable animal model for POP research.

Lifestyle factors, metabolic factors and socioeconomic status for pelvic organ prolapse: a Mendelian randomization study

BACKGROUND

Previous observational studies have reported that lifestyle factors, metabolic factors and socioeconomic status are associated with the development of female pelvic organ prolapse (POP); however, whether these associations are causal remains unclear. The current study aimed to assess the causal effect of lifestyle factors, metabolic factors and socioeconomic status on POP risk.

METHODS

We conducted a two-sample Mendelian randomization (MR) study based on summary-level data from the largest available genome-wide association studies (GWAS) to evaluate whether lifestyle factors, metabolic factors and socioeconomic status are causally related to POP. We used single nucleotide polymorphisms that are strongly associated with exposure at the genome-wide significance level (P < 5 × 10-8) as instrumental variables from genome-wide association studies. The method of random-effect inverse-variance weighting (IVW) was used as the primary analysis method, supplemented with the weighted median, MR-Egger and the MR pleiotropy residual sum and outlier applied to verify the MR assumptions. Two-step MR was conducted to investigate potential intermediate factors that are on the causal pathway from exposure to POP.

RESULTS

There were associations with POP for genetically predicted waist-to-hip ratio (WHR) (odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01-1.03 per SD-increase, P < 0.001), WHR adjusted for body mass index (WHRadjBMI) (OR 1.017, 95% CI 1.01-1.025 per SD-increase, P < 0.001) and education attainment (OR 0.986, 95% CI 0.98-0.991 per SD-increase) in the meta-analysis. Additionally, genetically predicted coffee consumption (OR per 50% increase 0.67, 95% CI 0.47-0.96, P = 0.03), vigorous physical activity (OR 0.83, 95% CI 0.69-0.98, P = 0.043) and high-density lipoprotein cholesterol (HDL-C) (OR 0.91, 95% CI 0.84-0.98 per SD-increase, P = 0.049) were inversely associated with POP in the FinnGen Consortium. The mediation analysis showed that the indirect effects of education attainment on POP were partly mediated by WHR and WHRadjBMI, with a mediated proportion of 27% and 13% in the UK Biobank study, respectively.

CONCLUSIONS

Our study provides MR evidence of a robust causal association of WHR, WHRadjBMI and education attainment with POP.

Prevalence of symptomatic pelvic organ prolapse and associated factors in Southern Nations, Nationalities, People's Region referral hospitals, Ethiopia

INTRODUCTION AND HYPOTHESIS

Pelvic organ prolapse is one of the major causes of morbidity among women that affect their quality of life. Despite the severity of the problem, there is limited information in Ethiopia. Therefore, this study was aimed at assessing the prevalence of symptomatic POP and its associated factors.

METHODS

An institution-based cross-sectional study was carried out in the referral hospitals of Southern Nations, Nationalities, People's Region, Ethiopia. Women were initially interviewed about their prolapse symptoms using validated questionnaires, and if they answered yes to one or more of the questions, they were examined by gynecologists using simplified POP quantification. Pelvic examination results and patient-reported symptoms were used to determine symptomatic POP. A multivariate logistic regression analysis model was used to identify factors associated with symptomatic prolapse.

RESULTS

A total of 1,196 respondents were included in this study. The prevalence of symptomatic POP was found to be 20.1%. Age of women ≥55 years (AOR=8.39; 95% CI 3.41-20.62), carrying heavy objects for ≥ 5 h (AOR= 5.18; 95% CI 2.51-10.69), parity ≥4 times (AOR=2.98; 95% CI 1.60-5.53), history of home delivery (AOR= 2.90; 95% CI 1.50-5.61), giving birth through assisted vaginal delivery (AOR=5.01; 95% CI 1.73-14.53), history of chronic constipation (AOR=2.66; 95% CI 1.38-5.15), and a history of a chronic cough (AOR=9.18; 95% CI 4.52-18.61) were associated with symptomatic POP.

CONCLUSIONS

In this study the prevalence of symptomatic POP is high. Older age, long hours of carrying heavy objects, a high parity, last birth through assisted vaginal delivery, a history of home delivery, a history of chronic constipation, and a history of a chronic cough were found to be associated with symptomatic POP.

One in ten ever-married women who visited health facilities for various reasons have pelvic organ prolapse in Harari regional state, Eastern Ethiopia

Background

Pelvic organ prolapse remains a neglected public health problem in developing countries. The burden of pelvic organ prolapse varies by region and ranges from 9 to 20%. It poses an impact on women’s quality of life and affects their role at the community and family level. Although it has negative consequences and extensive burden, the true feature of pelvic organ prolapse is not well known among ever-married women attending health facilities for various reasons in the study area. Therefore, this study was aimed to assess the magnitude of pelvic organ prolapse and associated factors among ever-married women attending health care services in public Hospitals, Eastern Ethiopia.

Methods

A facility-based cross-sectional study design was conducted from March 4th to April 5th, 2020 among 458 ever-married women attending public Hospitals in Harar town, Eastern Ethiopia. The study subjects were selected through systematic sampling. The data were collected using a structured questionnaire through face-to-face interviews. Data were analyzed using SPSS version 22 (IBM SPSS Statistics, 2013). The prevalence was reported by proportion and summary measures. Predictors were assessed using a multivariable logistic regression analysis model and reported using an adjusted odds ratio with 95% CI. Statistical significance was declared at p-value < 0.05.

Result

Of 458 women enrolled in the study, 10.5% of them had pelvic organ prolapse based on women’s reporting of symptoms. History of lifting heavy objects [AOR = 3.22, 95% CI (1.56, 6.67)], history of chronic cough [AOR = 2.51, 95% CI (1.18, 5.31)], maternal age of greater than or equal to 55 years [AOR = 3.51, 95% CI (1.04, 11.76)], history chronic constipation (AOR = 3.77, 95% CI (1.54, 9.22) and no history of contraceptive utilization [AOR = 2.41, 95% CI (1.13, 5.05)] were significantly associated with pelvic organ prolapse.

Conclusion

In this study, one in ten ever-married women who visited health facilities for various reasons have pelvic organ prolapse. Modifiable and non-modifiable risk factors were identified. This result provides a clue to give due consideration to primary and secondary prevention through various techniques.

Pelvic organ prolapse and associated factors among women admitted to gynecology ward at the Hiwot Fana Comprehensive Specialized Hospital, Harar, eastern Ethiopia

Objectives

The major aim of this study was to assess the magnitude of pelvic organ prolapse and its associated factors among patients admitted to the gynecology ward at Hiwot Fana Specialized University Hospital, eastern Ethiopia.

Methods

A retrospective review of records was undertaken at Hiwot Fana Specialized University Hospital. We used a simple random sampling technique to pick 387 gynecology ward-admitted patient records from 30 December 2020 to 10 January 2021. Data were extracted from maternal medical charts using a pretested checklist. The extracted data were entered into EpiData version 3.1 and then exported into SPSS version 25 for analysis. Binary logistic regression was carried out to observe a significant correlation between independent and pelvic organ prolapse. An adjusted odds ratio and 95% confidence interval was used to report the result. A p-value of less than 0.05 was used to declare statistical significance.

Results

Among 387 responded women, 39 (10.1%; 95% confidence interval = 8.3-15.6) of them had at least one stage of pelvic organ prolapse. Multiparty (adjusted odds ratio = 1.88, 95% confidence interval = 1.41-10.60), grand multiparty (adjusted odds ratio = 2.63, 95% confidence interval = 1.53-12.90), older maternal age (adjusted odds ratio = 2.29, 95% confidence interval = 1.220-7.52), lifting a heavy object (adjusted odds ratio = 4.61, 95% confidence interval = 2.31-15.83), and having chronic cough (adjusted odds ratio = 2.39, 95% confidence interval = 1.10-5.19) were significantly associated with pelvic organ prolapse.

Conclusion

Among women admitted to the hospital because of gynecological morbidity, one in ten of them had pelvic organ prolapse. Multiparty, advanced maternal age, having a chronic cough, and lifting heavy objects were identified to be risk factors for pelvic organ prolapse. Tailored primary prevention would enhance the well-being of reproductive-age women.

Robotic-Assisted Laparoscopic Sacrocolpopexy for Pelvic Organ Prolapse: A Single Center Experience in China

Objective. The aim is to investigate the efficiency and outcome of robotic-assisted sacrocolpopexy (RASC) in a cohort of patients with pelvic organ prolapse (POP) in our Gynecology Department. Methods. We performed a retrospective study of female patients who underwent RASC in Chinese PLA General Hospital from January 2013 to December 2020. Their clinical features included age, degree of prolapse, menopause time, body mass index, pregnancy, delivery, operation time, and bleeding volume. All patients were followed up for more than 6 months. POP-Q was recorded to evaluate the position of prolapsed organs. PFDI-20, PFIQ-7, and PGI-I were used to evaluate the life quality after surgery. Results. Twenty-four patients with POP received RASC in our center. The intraoperative bleeding was 86.9 ± 98.3 ml (20–300 ml). The operation time was 143.5 ± 47.3 min (60–240 minutes). The hospitalization time was 10.4 ± 2.1 days (8–16 days). And the follow-up time was 40.8 ± 22.0 months (6–72 months). In the POP-Q follow-up, postoperative Aa, Ba, Ap, Bp, and C were significantly improved than those before surgery ( $P<0.05$ ). The objective and subjective cure rate was 100%. PGI-I score was very good in 9 (9/24), very good in 10 (10/24), and good in 3 (3/24). Postoperative PFDI-20 and PFIQ-7 were 2.78 ± 3.82 and 1.57 ± 3.86, which decreased dramatically after surgery ( $P<0.05$ ). Mesh exposure occurred in 4 cases (16.7%) at 2–12 months. The exposed diameters were less than 1 cm in 3 cases (2 A/T3/S1) and 1-2 cm in 1 case (3 B/T3/S1). These mesh exposures healed after conservative observation or mesh excision. Conclusion. RASC for POP has the advantage of less bleeding and hospitalization time. It is a minimally invasive option for pelvic organ prolapse.

Age and/or postmenopausal status as risk factors for pelvic organ prolapse development: systematic review with meta-analysis

INTRODUCTION AND HYPOTHESIS

Age is named as a risk factor for pelvic organ prolapse (POP), despite not being the primary outcome for many observational studies. Postmenopausal status is another associated factor but has many confounders. We aimed to systematically review the role of age and/or postmenopausal status in POP development.

METHODS

Systematic review addressing age and hormones, more specifically by postmenopausal status, from inception to March 2020 in four databases (PubMed, Embase, WOS, Cochrane Library). Quality of evidence was classified by the ROBINS-I classification for non-randomized studies. Experimental studies, animal studies, studies linking age with recurrent POP and case series were excluded. Effect estimates were collected from adjusted odds ratio plus 95% confidence intervals. Significance level was 5%. A discussion exploring mechanistic factors was also included.

RESULTS

Nineteen studies (11 cross sectional, 6 cohort and 2 case control) were included for quantitative analysis. Only two studies presented a low overall risk of bias for age; most of the domains were of moderate risk. Every additional year was responsible for a 10% increase in the risk to develop POP (OR = 1.102 [1.021-1.190]; i² = 80%, random analysis, p = 0.012). This trend was confirmed when age was dichotomized into a cutoff of 35 (p = 0.035) and 50 (p < 0.001) years. Although an increase in the risk for POP was noted in postmenopausal women, this did not reach statistical significance (OR = 2.080 [0.927-4.668], i² = 0%, p = 0.076).

CONCLUSION

Age is a risk factor for POP; postmenopausal status was not statistically associated with POP, prompting the need for further studies addressing this factor.

Mesenchymal stem cell transplantation for vaginal repair in an ovariectomized rhesus macaque model

BACKGROUND

Current surgical therapies for pelvic organ prolapse (POP) do not repair weak vaginal tissue and just provide support; these therapies may trigger severe complications. Stem cell-based regenerative therapy, due to its ability to reconstruct damaged tissue, may be a promising therapeutic strategy for POP. The objective of this study is to evaluate whether mesenchymal stem cell (MSC) therapy can repair weak vaginal tissue in an ovariectomized rhesus macaque model.

METHODS

A bilateral ovariectomy model was established in rhesus macaques to induce menopause-related vaginal injury. Ten bilaterally ovariectomized rhesus macaques were divided into two groups (n=5/group): the saline group and the MSC group. Three months after ovariectomy, saline or MSCs were injected in situ into the injured vaginal wall. The vaginal tissue was harvested 12 weeks after injection for histological and biochemical analyses to evaluate changes of extracellular matrix, microvascular density, and smooth muscle in the vaginal tissue. Biomechanical properties of the vaginal tissue were assessed by uniaxial tensile testing. Data analysis was performed with unpaired Student's t test or Mann-Whitney.

RESULTS

Twelve weeks after MSC transplantation, histological and biochemical analyses revealed that the content of collagen I, elastin, and microvascular density in the lamina propria of the vagina increased significantly in the MSC group compared with the saline group. And the fraction of smooth muscle in the muscularis of vagina increased significantly in the MSC group. In addition, MSC transplantation improved the biomechanical properties of the vagina by enhancing the elastic modulus.

CONCLUSION

Vaginal MSC transplantation could repair the weak vaginal tissue by promoting extracellular matrix ingrowth, neovascularization, and smooth muscle formation and improve the biomechanical properties of the vagina, providing a new prospective treatment for POP.

Prevalence of pelvic organ prolapse among US racial populations: A systematic review and meta-analysis of population-based screening studies

AIMS

To determine the differences in pooled prevalence rates of symptomatic pelvic organ prolapse (POP) across different US racial/ethnic groups using existing screening-based epidemiologic studies.

METHODS

A systematic search of MEDLINE, EMBASE, Cochrane, and Scopus was conducted to retrieve eligible studies. We included studies that identified POP by either physical exam or questionnaire, conducted in non-gynecologic care-seeking settings, and had a representative sample of US community-dwelling women from more than one racial/ethnic group with prevalence rates reported for each population. Meta-analysis was performed with the pooled estimates calculated, and χ ² tests were performed to examine the associations between race and POP prevalence.

RESULTS

Of the 2604 studies reviewed, 5 were included. One study used physical exam findings while others used questionnaires to identify POP. All but one study demonstrated statistically significant differences in POP prevalence rates based on race/ethnicity. The overall pooled POP prevalence rates were determined for each racial/ethnic group-White women: 10.76% (95% confidence interval [CI], 10.30%-11.22%); Hispanic women: 6.55% (95% CI, 5.83%-7.28%); Black women: 3.80% (95% CI, 3.22%-4.38%); and Asian American women: 3.40% (95% CI, 2.09%-4.71%). There was a significant difference in the pooled prevalence rates among these four racial/ethnic groups (p < 0.01).

CONCLUSIONS

Our study found that White women had the highest pooled POP prevalence rate overall, while Hispanic women had the highest pooled prevalence among minority women. Additionally, American Indians and Pacific Islanders were absent from the current prolapse epidemiologic literature.

Factors associated with delay in seeking treatment among women with pelvic organ prolapse at selected general and referral hospitals of Southern Ethiopia, 2020

BACKGROUND

Pelvic organ prolapse (POP) is the descent of the vaginal wall, cervix, uterus, bladder, and rectum downward into the vaginal canal. Its prevalence is higher among women in developing countries because women are more prone to risk factors. In Ethiopia, women with prolapse seek treatments at advanced stages of prolapse; hence, surgical management has been widely practicing. Therefore, it was found to be very important to conduct research that assesses factors hindering early treatments in Southern Ethiopia. This study aimed to find out factors associated with the delay in seeking treatment of pelvic organ prolapse among patients at selected general and referral hospitals of Southern Ethiopia.

METHODS

Cross-sectional study design was employed in 123 participants of seven randomly selected General and Referral Hospitals of Southern Ethiopia from February 01 to April 30, 2020, by using a structured questionnaire. Pre-trained two midwives in each center were deployed to collect data. Physicians performed diagnosis and physical examination. Data were entered and coded using EPI INFO version 7 and exported into SPSS version 25 for analysis. Bivariate and multivariable logistic regression analyses were performed. The goodness of fit was assessed by using the Hosmer and Lemeshow goodness test.

RESULTS

In this study, out of 123 clinically diagnosed POP cases, nearly half of them were stage III, and over one-third were stage IV. Therefore, 84.6% (104 participants) of the respondents were delayed for the treatment of POP. The mean length of delay for POP treatments was 36.41 ± 3.95 months. After adjusting for covariates, lack of supports [AOR (Adjusted Odds Ratio) = 5.2 (95% CI 1.4-19.5)], low-income [AOR = 5.8 (95% CI 1.1-19.66)], and fear of social stigma [AOR = 4.7 (95% CI 1.2-18.59)] were significant factors for delayed treatments.

CONCLUSIONS

Most of the POP patients were delayed for POP treatments. Factors like lack of support, low-income, and fear of losing social value/stigma were associated with treatment delay. Screening for the POP cases, educating (making awareness) the community about this devastating disease to facilitate early treatment and to avoid social stigma, and raising access to treatment by making the nearby hospitals equipped with facilities to treat POP are recommended.

Pelvic Floor Considerations in COVID-19

BACKGROUND

Much of the research and clinical commentary on COVID-19 have been focused on respiratory function. Pelvic floor therapists understand that both respiratory dysfunction and hospitalization can have an impact on pelvic floor function. This clinical commentary provides context as to how the long-term effects of COVID-19 could affect the pelvic floor as well as some generalized treatment considerations.

DISCUSSION

The respiratory diaphragm has an impact on the ability of the pelvic floor to contract and relax in a manner that will allow for both continence and elimination. COVID-19 survivors often have disability in this muscle of respiration that can lead to implications for both overactive and underactive pelvic floor. Commonly, this population is hospitalized for long periods of time, which can have long-term consequences on both bladder and bowel functioning including, but not limited to, incontinence, urinary retention, and constipation. Pelvic floor therapists must be prepared to adjust both their evaluation and treatment methods in consideration of this novel treatment population.

CONCLUSIONS

Because of the pervasive nature of this virus, pelvic floor physical therapists should be a part of the rehabilitation team treating these patients once they have become medically stable.Video abstract with sound available at http://links.lww.com/JWHPT/A36.

Pelvic organ prolapse in Northwest Ethiopia: a population-based study

INTRODUCTION AND HYPOTHESIS

Epidemiological studies aimed at pelvic organ prolapse and its risk factors can help to identify women at a higher risk and therefore promote prevention strategies. We aimed to assess the prevalence of and factors associated with symptomatic prolapse.

METHODS

A community-based study was conducted in Dabat district, Northwest Ethiopia. Initially, women were interviewed on their prolapse symptoms using validated questionnaires at their home. Subsequently, they were invited for pelvic examination and examined by gynecologists using the simplified pelvic organ prolapse quantification. Symptomatic prolapse was assessed by pelvic examination findings and patient-reported symptoms. Multivariate logistic regression was used to assess the factors associated with symptomatic prolapse.

RESULTS

A total of 880 women were interviewed and invited for pelvic examination, of whom 824 (93.6%) showed up for examination. Of the 824 women examined, 464 (56.3%) had POP stages II-IV and 145 (17.6%) had POP stages III-IV. The overall prevalence of symptomatic prolapse was 46.7% (217 out of 464). Of these, 41.0%, 42.8%, and 3.2% accounted for stage II, III, and IV respectively. Increasing age, multiparity, and heavy lifting/carrying significantly increased the odds of developing symptomatic prolapse.

CONCLUSIONS

Symptomatic prolapse affects a substantial proportion of women in the study area and increased with age. Multiparity and carrying heavy objects are associated with prolapse, all of which have the potential to be modified. More attention is needed to improve prevention, diagnosis, and treatment services to mitigate the health burden of these at-risk women.