Vaginal Descent and Pelvic Floor Symptoms in Postmenopausal Women

Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242, USA.
Obstetrics and Gynecology (Impact Factor: 5.18). 06/2008; 111(5):1148-53. DOI: 10.1097/AOG.0b013e31816a3b96
Source: PubMed


To determine whether vaginal descent changes are associated with pelvic floor symptoms in postmenopausal women.
This 4-year prospective study included 260 postmenopausal women with an intact uterus enrolled at one Women's Health Initiative (WHI) clinical trial site. All completed at least two annual pelvic organ prolapse quantification (POP-Q) examinations and symptom questionnaires (30 bladder, bowel, and prolapse symptom items, modified from the Pelvic Floor Distress Inventory). Symptoms were grouped, and group scores categorized into two or three evenly distributed levels. Year 4 data collection was incomplete because the overall WHI study halted. Generalized logistic linear models and generalized estimating equation methods were used to measure associations between vaginal descent and a symptom or symptom score, controlling for time, age, and body mass index (BMI).
Mean age was 68+/-5 years, BMI 30+/-6 kg/m(2), and median parity 4. Ninety-five percent of women had POP-Q stages I-II prolapse. Increasing maximal vaginal descent was associated with "see/feel a bulge" and "sensation of protrusion or bulging," and with obstructive bladder, prolapse, and obstructive bowel scores. Increasing apical descent (POP-Q point C) was associated with "see/feel a bulge," increasing anterior descent (POP-Q point Ba) with bladder pain and obstructive bladder scores, and increasing posterior descent (POP-Q point Bp) with the bowel incontinence score.
Although previous work showed that most pelvic floor symptoms correlated poorly with levels of early prolapse, longitudinal analysis suggests that vaginal descent progression over time is positively associated with various bladder, bowel, and prolapse symptoms in postmenopausal women with stages I-II prolapse.

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    • "In the current study, parity, prior UI surgery/treatment, POP-Q stage, hormonal status, and incontinence episode frequency were not independently associated with UUI or bother from UUI and LUTS as measured by the UDI-I and MESA urge. Our findings that vaginal anatomy and support were not related to LUTS are consistent with previous studies [18, 19]. Although parity has been reported as a risk factor for urgency and UUI [17, 20]; when subjects with pure or predominant UUI are studied, parity tends to show an association with SUI and/or MUI, but not with UUI [15, 16, 21]. "
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    ABSTRACT: To investigate whether the nature of the anatomic defects in pelvic organ prolapse (POP) correlates with the character of the symptoms. This study was a cross-sectional investigation within a population-based sample. Two hundred eighty women who had completed a symptom questionnaire were examined according to POP quantification by two gynecologists blinded to symptom reports. An age- and parity-adjusted logistic regression model, controlling for POP in other compartments, revealed that the feeling of vaginal bulge was specific to prolapse but not to any particular compartment, although the association was strongest with anterior-wall prolapse (odds ratio [OR] for the symptom among women with stage II-IV relative to stage 0 was 5.8, 95% confidence interval [CI] 2.5-13.3). Urge urinary incontinence tended to be linked to POP in either the anterior or posterior wall, but the association was stronger with anterior-wall prolapse. Stress urinary incontinence was strongly linked to posterior-wall prolapse (stage II-IV OR 5.4, 95% CI 1.9-15.2). Self-reports of hard/lumpy stool and difficult or painful defecation tended to be associated with anterior-wall prolapse but without consistent relationships with stage. Painful defecation was the only bowel symptom significantly linked to posterior-wall prolapse (P=.05). Pelvic floor-related symptoms do not predict the anatomic location of the prolapse in women with mild to moderate prolapse.
    Obstetrics and Gynecology 11/2008; 112(4):851-8. DOI:10.1097/AOG.0b013e318187c550 · 5.18 Impact Factor
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    ABSTRACT: Estimation on prevalence and distribution of pelvic organ prolapse (POP) signs in a general female population is difficult. We therefore developed and validated a prediction model and prognostic instrument. Questionnaires were sent to a general female population (45-85 years). A random sample underwent vaginal examination for POP (POPQ). A prediction model was developed using multivariate analysis and validated in a subgroup of participants. Positive questionnaire-response rate was 46.8% (1,397 of 2,979). From the questionnaire group, 649 women were vaginally examined (46.5%). Prevalence of clinically relevant POP was 21%. Multivariate analysis demonstrated significantly higher odds ratios on the report of vaginal bulging, parity > or = 2 and a mother with POP. The receiver operating characteristic curve showed areas under the curve of 0.672 and 0.640. The prevalence of POP at or beyond the hymen could be estimated in a general female population using our prediction model with 17 questions and our POP score chart with eight questions.
    International Urogynecology Journal 06/2009; 20(9):1013-21. DOI:10.1007/s00192-009-0903-0 · 1.96 Impact Factor
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