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Epidemiology of Pelvic Organ Prolapse

  • Pelvic Organ Prolapse (M Weinstein, Section Editor)
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Abstract

Understanding and applying the epidemiology of pelvic organ prolapse (POP) is necessary to provide quality patient care to a growing and aging female population. As the elderly population is expected to almost double from 2012 to 2050, POP will become more prevalent, placing greater demands on our health care system and specialty-trained providers. In this review, we will evaluate and summarize recent literature and also highlight older studies of clinical significance that contribute to an overall understanding of the topic. While prevalence rates vary, the proportion of women with bothersome POP symptoms is approximately 3–6 % of women. POP is associated with decreased quality of life and a variety of bowel, bladder, and sexual dysfunction symptoms. Treatment options include expectant management, nonsurgical options, and surgery. For this review, we will review the prevalence of POP, trends in the management of POP, and future care needs with regard to POP.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014a;123(1):141–8. More recent than Nygaard et al. and with data from 2005 to 2010, this study used NHANES data to assess national POP prevalence trends over time and identify factors associated with these disorders to better target prevention efforts.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J. 2013;24(11):1783–90.

    Article  PubMed  Google Scholar 

  4. Hall AF, Theofrastous JP, Cundiff GW, Harris RL, Hamilton LF, Swift SE, et al. Interobserver and intraobserver reliability of the proposed International Continence Society, Society of Gynecologic Surgeons, and American Urogynecologic Society pelvic organ prolapse classification system. Am J Obstet Gynecol. 1996;175(6):1467–70. discussion 70–1.

    Article  CAS  PubMed  Google Scholar 

  5. Swift S, Woodman P, O’Boyle A, Kahn M, Valley M, Bland D, et al. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol. 2005;192(3):795–806.

    Article  PubMed  Google Scholar 

  6. Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186(6):1160–6.

    Article  PubMed  Google Scholar 

  7. Cooper J, Annappa M, Dracocardos D, Cooper W, Muller S, Mallen C. Prevalence of genital prolapse symptoms in primary care: a cross-sectional survey. Int Urogynecol J. 2015;26(4):505–10.

    Article  PubMed  Google Scholar 

  8. Ellerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler K, Bent AE. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol. 2001;185(6):1332–7. discussion 7–8.

    Article  CAS  PubMed  Google Scholar 

  9. Doaee M, Moradi-Lakeh M, Nourmohammadi A, Razavi-Ratki SK, Nojomi M. Management of pelvic organ prolapse and quality of life: a systematic review and meta-analysis. Int Urogynecol J. 2014;25(2):153–63.

    Article  PubMed  Google Scholar 

  10. Swift SE, Tate SB, Nicholas J. Correlation of symptoms with degree of pelvic organ support in a general population of women: what is pelvic organ prolapse? Am J Obstet Gynecol. 2003;189(2):372–7. discussion 7–9.

    Article  PubMed  Google Scholar 

  11. Gutman RE, Ford DE, Quiroz LH, Shippey SH, Handa VL. Is there a pelvic organ prolapse threshold that predicts pelvic floor symptoms? Am J Obstet Gynecol. 2008;199(6):683 e1–7.

    Article  PubMed  Google Scholar 

  12. Bradley CS, Zimmerman MB, Qi Y, Nygaard IE. Natural history of pelvic organ prolapse in postmenopausal women. Obstet Gynecol. 2007;109(4):848–54.

    Article  PubMed  Google Scholar 

  13. Gilchrist AS, Campbell W, Steele H, Brazell H, Foote J, Swift S. Outcomes of observation as therapy for pelvic organ prolapse: a study in the natural history of pelvic organ prolapse. Neurourol Urodyn. 2013;32(4):383–6. This study assessed progression and regression rates in women with symptomatic POP who elected for expectant management. Traditionally, data has been very limited regarding the natural history of POP; this study is important because it demonstrates that POP is not a universally progressive disease and therefore may help patients and providers to make better decisions about when to pursue treatment.

    Article  PubMed  Google Scholar 

  14. Gyhagen M, Akervall S, Milsom I. Clustering of pelvic floor disorders 20 years after one vaginal or one cesarean birth. Int Urogynecol J. 2015;26(8):1115–21.

    Article  PubMed  Google Scholar 

  15. Bai SW, Jeon MJ, Kim JY, Chung KA, Kim SK, Park KH. Relationship between stress urinary incontinence and pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(4):256–60. discussion 60.

    Article  CAS  PubMed  Google Scholar 

  16. Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011;12, CD003882.

    PubMed  Google Scholar 

  17. Wiegersma M, Panman CM, Kollen BJ, Berger MY, Lisman-Van Leeuwen Y, Dekker JH. Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care. BMJ. 2014a;349:g7378.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Alperin M, Khan A, Dubina E, Tarnay C, Wu N, Pashos CL, et al. Patterns of pessary care and outcomes for Medicare beneficiaries with pelvic organ prolapse. Female Pelvic Med Reconstr Surg. 2013;19(3):142–7.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wiegersma M, Panman CM, Kollen BJ, Vermeulen KM, Schram AJ, Messelink EJ, et al. Pelvic floor muscle training versus watchful waiting or pessary treatment for pelvic organ prolapse (POPPS): design and participant baseline characteristics of two parallel pragmatic randomized controlled trials in primary care. Maturitas. 2014b;77(2):168–73.

    Article  PubMed  Google Scholar 

  20. Bump RC, Norton PA. Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin North Am. 1998;25(4):723–46.

    Article  CAS  PubMed  Google Scholar 

  21. Wu JM, Matthews CA, Conover MM, Pate V, Jonsson FM. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014b;123(6):1201–6. This population-based study estimated that the lifetime risk of undergoing surgery for POP is 12.6%, which represents current surgical practice among women with employer-based insurance from across the USA.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Smith FJ, Holman CD, Moorin RE, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010;116(5):1096–100.

    Article  PubMed  Google Scholar 

  23. Lowenstein E, Ottesen B, Gimbel H. Incidence and lifetime risk of pelvic organ prolapse surgery in Denmark from 1977 to 2009. Int Urogynecol J. 2015;26(1):49–55.

    Article  PubMed  Google Scholar 

  24. Oversand SH, Staff AC, Spydslaug AE, Svenningsen R, Borstad E. Long-term follow-up after native tissue repair for pelvic organ prolapse. Int Urogynecol J. 2014;25(1):81–9. This study demonstrated very high satisfaction rates and low re-operation rates after native tissue repair for primary POP. This data is important because in an era when mesh augmentation is common and prior rates of re-operation have been reported as high as 29%, this supports native tissue repair as an appropriate first-line intervention for primary POP.

    Article  PubMed  Google Scholar 

  25. Risk of a subsequent surgery after an initial stress incontinence and/or pelvic organ prolapse procedure. American Urogynecologic Society, Seattle, WA, Oct 13–17, 2015. [Abstract] Female Pelvic Med Reconstr Surg. 2015 Sept/Oct. 21(5 Supp 2):S43.

  26. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6.

    Article  CAS  PubMed  Google Scholar 

  27. Rogo-Gupta L, Rodriguez LV, Litwin MS, Herzog TJ, Neugut AI, Lu YS, et al. Trends in surgical mesh use for pelvic organ prolapse from 2000 to 2010. Obstet Gynecol. 2012;120(5):1105–15.

    PubMed  Google Scholar 

  28. Jonsson Funk M, Edenfield AL, Pate V, Visco AG, Weidner AC, Wu JM. Trends in use of surgical mesh for pelvic organ prolapse. Am J Obstet Gynecol. 2013;208(1):79 e1–7.

    Article  PubMed  Google Scholar 

  29. Skoczylas LC, Turner LC, Wang L, Winger DG, Shepherd JP. Changes in prolapse surgery trends relative to FDA notifications regarding vaginal mesh. Int Urogynecol J. 2014;25(4):471–7.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Mascarenhas T, Mascarenhas-Saraiva Jr M, Ricon-Ferraz A, Nogueira P, Lopes F, Freitas A. Pelvic organ prolapse surgical management in Portugal and FDA safety communication have an impact on vaginal mesh. Int Urogynecol J. 2015;26(1):113–22.

    Article  PubMed  Google Scholar 

  31. Ortman JM VV, Hogan H. An aging nation: the older population in the United States. Department of Commerce Economics and Statistics Administration; 2014 [December 1, 2015]; Available from: http://www.census.gov/prod/2014pubs/p25-1140.pdf.

  32. Wu JM, Hundley AF, Fulton RG, Myers ER. Forecasting the prevalence of pelvic floor disorders in US Women: 2010 to 2050. Obstet Gynecol. 2009;114(6):1278–83.

    Article  PubMed  Google Scholar 

  33. Kirby AC, Luber KM, Menefee SA. An update on the current and future demand for care of pelvic floor disorders in the United States. Am J Obstet Gynecol. 2013;209(6):584 e1–5.

    Article  Google Scholar 

  34. Yune JJ, Siddighi S. Perceptions and practice patterns of general gynecologists regarding urogynecology and pelvic reconstructive surgery. Female Pelvic Med Reconstr Surg. 2013;19(4):225–9.

    Article  PubMed  Google Scholar 

  35. Casiano ER, Wendel Jr GD, Congleton MJ, Wai CY. Urogynecology training and practice patterns after residency. J Surg Educ. 2012;69(1):77–83.

    Article  PubMed  Google Scholar 

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Correspondence to Maggie F. Wilkins.

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Conflict of Interest

Maggie. F. Wilkins declares no conflict of interest.

Jennifer M. Wu declares grant support from Boston Scientific for an industry-sponsored study on POP surgery and long-term outcomes.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Financial Support

Dr. Wu is supported by K23HD068404, Eunice Kennedy Shriver National Institute of Child Health & Human Development.

Additional information

This article is part of the Topical Collection on Pelvic Organ Prolapse

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Wilkins, M.F., Wu, J.M. Epidemiology of Pelvic Organ Prolapse. Curr Obstet Gynecol Rep 5, 119–123 (2016). https://doi.org/10.1007/s13669-016-0149-z

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