International Urogynecology Journal

, Volume 22, Issue 2, pp 127–135 | Cite as

Pelvic organ prolapse and incontinence in developing countries: review of prevalence and risk factors

Review Article


Introduction and hypothesis

Information on the prevalence, risk factors and social consequences of pelvic floor dysfunction (PFD) affecting women in 16 low-income and lower middle-income countries is reviewed.


Medline searches were performed for articles dealing with prevalence of PFD.


Thirty studies were identified. The mean prevalence for pelvic organ prolapse was 19.7% (range 3.4–56.4%), urinary incontinence (UI) was 28.7% (range 5.2–70.8%) and faecal incontinence (FI) was 6.9% (range 5.3–41.0%). Risk factors for PFD are similar to those in more affluent countries particularly increased age and parity, but additionally, PFD is associated with other factors including poor nutrition and heavy work. The social consequences of PFD conditions can be devastating.


Pelvic organ prolapse and urinary and faecal incontinence are significant problems in developing countries. Access to health care to manage these conditions is often limited, and women usually have to live with the consequences for the rest of their lives.


Pelvic organ prolapse Prevalence Risk factors Urinary and faecal incontinence 



Pelvic floor dysfunction


Pelvic organ prolapse


Urinary incontinence


Faecal incontinence


Odds ratio


Confidence interval


Interview and examination




Conflicts of interest



  1. 1.
    Ahmed S, Holtz SA (2007) Social and economic consequences of obstetric fistula: life changed for ever. Int J Gynaecol Obstet 99:S10–S15CrossRefPubMedGoogle Scholar
  2. 2.
    Patel DA, Xu X, Thomason AD, Ransom SB, Ivy JS, De Lancey JOL (2006) Childbirth and pelvic floor dysfunction: an epidemiologic approach to the assessment of prevention opportunities at delivery. Am J Obstet Gynecol 195:23–28CrossRefPubMedGoogle Scholar
  3. 3.
    Swift S, Woodman P, O'Boyle A, Kahn M, Valley M, Bland D et al (2005) Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 192:795–806CrossRefPubMedGoogle Scholar
  4. 4.
    Subramanian D, Szwarcensztein K, Mauskopf JA, Slack MC (2009) Rate, type, and cost of pelvic organ prolapse surgery in Germany, France, and England. Eur J Obstet Gynecol Reprod Biol 144:177–181CrossRefPubMedGoogle Scholar
  5. 5.
    Jelovsek JE, Moher C, Barber MD (2007) Pelvic organ prolapse. Lancet 369:1027–1038CrossRefPubMedGoogle Scholar
  6. 6.
    Gunasekera P, Sazaki J, Walker G (2007) Pelvic organ prolapse: don't forget developing countries. Lancet 369:1789–1790CrossRefPubMedGoogle Scholar
  7. 7.
  8. 8.
    Bonetti TR, Erpelding A, Pathak LR (2004) Listening to “felt needs”: investigating genital prolapse in Western Nepal. Reprod Health Matters 12:166–175CrossRefPubMedGoogle Scholar
  9. 9.
    Ministry of Health and Population, Nepal, New Era and Macro International Inc. (2007) Nepal Demographic and Health Survey 2006. New Era and Macro International Inc., Kathmandu, Nepal: Ministry of Health and PopulationGoogle Scholar
  10. 10.
    Wusu-Ansah OK, Opare-Addo HS (2008) Pelvic organ prolapse in rural Ghana. Int J Gynaecol Obstet 103:121–124CrossRefPubMedGoogle Scholar
  11. 11.
    Sajan F, Fikree FF (2002) Does early age at marriage influence gynaecological morbidities among Pakistani women? J Biosoc Sci 34:407–417CrossRefPubMedGoogle Scholar
  12. 12.
    Younis N, Khattab H, Zurayk H, el-Mouelhy M, Amin MF, Farag AM (1993) A community study of gynaecological and related morbidities in rural Egypt. Stud Fam Plann 24:175–185CrossRefPubMedGoogle Scholar
  13. 13.
    Bhatia JC, Cleland J, Bhagavan L, Rao NSN (1997) Levels and determinants of gynecological morbidity in a district of south India. Stud Fam Plann 28:95–103CrossRefPubMedGoogle Scholar
  14. 14.
    Kumari S, Walia I, Singh A (2000) Self-reported prolapse in a resettlement colony of north India. J Midwifery Women's Health 45:343–350CrossRefGoogle Scholar
  15. 15.
    Garshasbi A, Faghih-Zadeh S, Falah N (2006) The status of pelvic supporting organs in a population of Iranian women 18–68 years of age and possible related factors. Arch Iran Med 9:124–128PubMedGoogle Scholar
  16. 16.
    Adanu RM, De Lancey JO, Miller JM, Asante A (2006) The physical finding of stress urinary incontinence among African women in Ghana. Int Urogynecol J Pelvic Floor Dysfunct 17:581–585CrossRefPubMedGoogle Scholar
  17. 17.
    Andrades M, Paul R, Ambreen A, Dodani S, Dhanani RH, Qidwai W (2004) Distribution of lower urinary tract symptoms (LUTS) in adult women. J Coll Physicians Surg Pak 14:132–135PubMedGoogle Scholar
  18. 18.
    Rizvi RM, Nazim MH (2005) The frequency of urinary symptoms in women attending gynaecology clinics at the Aga Khan University Hospital Karachi, Pakistan. J Pak Med Assoc 55:489–492PubMedGoogle Scholar
  19. 19.
    Song YF, Zhang WJ, Song J, Xu B (2005) Prevalence and risk factors of urinary incontinence in Fuzhou Chinese women. Chin Med J (Engl) 118:887–892Google Scholar
  20. 20.
    Zhang W, Song Y, He X, Xu B, Huang H, He C et al (2005) Prevalence and risk factors of lower urinary tract symptoms in Fuzhou Chinese women. Eur Urol 48:309–313CrossRefPubMedGoogle Scholar
  21. 21.
    Zhu L, Lang J, Wang H, Han S, Huang J (2008) The prevalence of and potential risk factors for female urinary incontinence in Beijing, China. Menopause 15:566–569CrossRefPubMedGoogle Scholar
  22. 22.
    Zhu L, Li L, Lang J, Xu T, Wong F (2010) Epidemiology of mixed urinary incontinence in China. Int J Gynecol Obstet 109:55–58CrossRefGoogle Scholar
  23. 23.
    Zhu L, Lang J, Liu C, Han S, Huang J, Li X (2009) The epidemiological study of women with urinary incontinence and risk factors for stress incontinence in China. Menopause 15:566–569CrossRefGoogle Scholar
  24. 24.
    Zhu L, Lang J, Liu C, Xu T, Liu X, Li L et al (2010) Epidemiological study of urge urinary incontinence and risk factors in China. Int Urogynecol J 21:589–593CrossRefGoogle Scholar
  25. 25.
    El-Azab AS, Mohamed EM, Sabra HI (2007) The prevalence and risk factors of urinary incontinence and its influence on the quality of life among Egyptian women. Neurourol Urodyn 26:783–788CrossRefPubMedGoogle Scholar
  26. 26.
    Sobhgol SS, Charandabee SM (2008) Related factors of urge, stress, mixed urinary incontinence and overactive bladder in reproductive age women in Tabriz, Iran: a cross-sectional study. Int Urogynecol J Pelvic Floor Dysfunct 19:367–373CrossRefPubMedGoogle Scholar
  27. 27.
    Shakhatreh FM (2005) Epidemiology of urinary incontinence in Jordanian women. Saudi Med J 26:830–835PubMedGoogle Scholar
  28. 28.
    Shakhatreh FMH, Mas'ad D (2006) Menopausal symptoms and health problems of women aged 50–65 years in Southern Jordan. Climacteric 9:305–311CrossRefPubMedGoogle Scholar
  29. 29.
    Mikou F, Abbassi O, Benjelloun A, Matar N, el Mansouri A (2001) Prevalence of urinary incontinence in Moroccan women. Report of 1, 000 cases. Ann Urol (Paris) 35:280–289Google Scholar
  30. 30.
    Sakondhavat C, Choosuwan C, Kaewrudee S, Soontrapa S, Louanka K (2007) Prevalence and risk factors of urinary incontinence in Khon Kaen menopausal women. J Med Assoc Thai 90:2553–2558PubMedGoogle Scholar
  31. 31.
    Manonai J, Poowapirom A, Kittipiboon S, Patrachai S, Udomsubpayakul U, Chittacharoen A (2006) Female urinary incontinence: a cross-sectional study from a Thai rural area. Int Urogynecol J Pelvic Floor Dysfunct 17:321–325CrossRefPubMedGoogle Scholar
  32. 32.
    Manonai J, Chittacharoen A, Sarit-apirak S, Udomsubpayakul U, Khanacharoen A, Theppisai U (2004) Lower urinary tract symptoms in Thai women attending the menopause clinic: prevalence and associated factors. J Med Assoc Thai 87:1265–1269PubMedGoogle Scholar
  33. 33.
    Keskes J, Khairi H, Ben Said A, Hidar M, Pigné A (1988) Stress urinary incontinence in women. Epidemiologic inquiry. Apropos of 500 cases. J Gynecol Obstet Biol Reprod (Paris) 17:453–460Google Scholar
  34. 34.
    Scherf C, Morison L, Fiander A, Ekpo G, Walraven G (2002) Epidemiology of pelvic organ prolapse in rural Gambia, West Africa. BJOG 109:431–436CrossRefPubMedGoogle Scholar
  35. 35.
    Sadeghi-Hassanabadi A, Keshavarz H, Setoudeh-Maram SZ (1998) Prevalence of reproductive morbidity among women of the Qashaq'I tribe, Islamic Republic of Iran. East Mediterr Health J 4:312–318Google Scholar
  36. 36.
    Al-Qutob R (2001) Menopause-associated problems: types and magnitude. A study in the Ain Al-Basha area, Jordan. J Adv Nurs 33:613–620CrossRefPubMedGoogle Scholar
  37. 37.
    Mawajdeh SM, Al-Qutob R, Schmidt A (2003) Measuring reproductive morbidity: a community-based approach, Jordan. Health Care Women Int 24:635–649CrossRefPubMedGoogle Scholar
  38. 38.
    National Statistics Office (NSO) [Philippines] and Macro International Inc. (MI) (1994) National Demographic Survey 1993. NSO and MI, Calverton, MarylandGoogle Scholar
  39. 39.
    Okonkwo JE, Obionu CO, Obiechina NJ (2001) Factors contributing to urinary incontinence and pelvic prolapse in Nigeria. Int J Gynaecol Obstet 74:301–303CrossRefPubMedGoogle Scholar
  40. 40.
    Okonkwo JE, Obionu CN, Okonkwo CV, Obiechina NJ (2002) Anal incontinence among Igbo (Nigerian) women. Int J Clin Pract 56:178–180PubMedGoogle Scholar
  41. 41.
    Ozel B, Borchelt AM, Cimino FM, Cremer M (2007) Prevalence and risk factors for pelvic floor symptoms in women in rural El Salvador. Int Urogynecol J Pelvic Floor Dysfunct 18:1065–1069CrossRefPubMedGoogle Scholar
  42. 42.
    Premachandra ND, Kotalawala SW, Cooray R, Samarasekera DN (2008) Anal incontinence in the aging Sri Lankan population: the results of a pilot study. Ceylon Med J 53:154PubMedGoogle Scholar
  43. 43.
    Bodner-Adler B, Shrivastava C, Bodner K (2007) Risk factors for uterine prolapse in Nepal. Int Urogynecol J Pelvic Floor Dysfunct 18:1343–1346CrossRefPubMedGoogle Scholar
  44. 44.
    Ravindran TK, Savitri R, Bhavani A (1999) Women's experiences of utero-vaginal prolapse: a qualitative study from Tamil Nadu, India. In: Berer M, Sundari TK (eds) Safe motherhood initiatives: critical issues. Blackwell Science, Oxford, pp 166–172Google Scholar
  45. 45.
    Zhu L, Bian XM, Long Y, Lang JH (2008) Role of different childbirth strategies on pelvic organ prolapse and stress urinary incontinence: a prospective study. Chin Med J (Engl) 121:213–215Google Scholar
  46. 46.
    Lukman Y (1995) Utero-vaginal prolapse: a rural disability of the young. East Afr Med J 72:2–9PubMedGoogle Scholar
  47. 47.
    Komorowski L, Chen B (2006) Female urinary incontinence in China: experiences and perspectives. Health Care Women Int 27:169–181CrossRefPubMedGoogle Scholar
  48. 48.
    Fernando RJ, Thakar R, Sultan AH, Shah SM, Jones PW (2006) Effect of vaginal pessaries on symptoms associated with pelvic organ prolapse. Obstet Gynecol 108:93–99CrossRefPubMedGoogle Scholar
  49. 49.
    Cundiff GW, Weidner AC, Visco AG, Bump RC, Addison WA (2000) A survey of pessary use by members of the American Urogynecologic Society. Obstet Gynecol 95:931–935CrossRefPubMedGoogle Scholar
  50. 50.
    Richardson K, Hagen S, Glazener C, Stark D (2009) The role of nurses in the management of women with pelvic organ prolapse. Br J Nurs 18:294–300PubMedGoogle Scholar
  51. 51.
    Schaaf JM, Dongol A, van der Leeuw-Harmsen (2008) Follow-up of prolapse surgery in rural Nepal. Int Urogynecol J Pelvic Floor Dysfunct 19:851–855CrossRefPubMedGoogle Scholar
  52. 52.
    Bhatia MR, Yesudian CAK, Gorter A, Thankappan (2006) Demand side financing for reproductive and child health services in India. Econ Polit Wkly 41:279–284Google Scholar
  53. 53.
    Zurayk H, Khattab H, Younis N, Kamal O, El-Helw M (1995) Comparing women's reports with medical diagnoses of reproductive morbidity conditions in rural Egypt. Stud Fam Plann 26:14–21CrossRefPubMedGoogle Scholar
  54. 54.
    Minassian VA, Drutz HP, Al-Badr A (2003) Urinary incontinence as a worldwide problem. Int J Gynaecol Obstet 82:327–338CrossRefPubMedGoogle Scholar
  55. 55.
    Kenton K, Mueller ER (2006) The global burden of female pelvic floor disorders. BJU Int 98(Suppl 1):1–5CrossRefPubMedGoogle Scholar
  56. 56.
    Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E et al (2010) International Urogynecological Association; International Continence Society. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 29:4–20PubMedGoogle Scholar
  57. 57.
    Treszezamsky AD, Rascoff L, Shahryarinejad A, Vardy MD (2010) Use of pelvic organ prolapse staging systems in published articles of selected specialized journals. Int Urogynecol J Pelvic Floor Dysfunct 21:359–363CrossRefPubMedGoogle Scholar
  58. 58.
    Rizk DE (2009) Minimizing the risk of childbirth-induced pelvic floor dysfunctions in the developing word: “preventive” urogynecology. Int Urogynecol J Pelvic Floor Dysfunct 20:615–617CrossRefPubMedGoogle Scholar

Copyright information

© The International Urogynecological Association 2010

Authors and Affiliations

  1. 1.Cochrane Pregnancy and Childbirth Group, School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive MedicineUniversity of LiverpoolLiverpoolUK
  2. 2.UNFPAKabulAfghanistan
  3. 3.LondonUK

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