Abstract
ABSTRACTThe exact prevalence of pelvic organ prolapse is difficult to establish. The anatomical changes do not always consist with the severity or the symptoms associated with prolapse. There are many risk factors associated with pelvic organ prolapse and this review aims to identify the epidemiology and pathophysiology while looking at the known risk factors for pelvic organ prolapse. PubMed search involved a number of terms including: epidemiology, risk factors, reoccurrence indicators, management and evaluation. Several risk factors have been associated with pelvic organ prolapse, all contribute to weakening of the pelvic floor connective tissue/collagen, allowing the pelvic organs to prolapse through the vaginal walls. Among the risk factors are genetic background, childbirth and mode of delivery, previous hysterectomy, menopausal state and the ratio between Estrogen receptors. The “Integral theory” of Petros and the “Levels of Support” model of Delancey enable us to locate the defect, diagnose and treat pelvic organ prolapse.The currently available demographic data is not reliable enough to properly estimate the true extent of pelvic organ prolapse in the population. However, standardization of the diagnosis and treatment may significantly improve our ability to estimate the true incidence and prevalence of this condition in the coming years.
Highlights
Pelvic organ prolapse (POP) is a disturbing problem, which affect many women and their quality of life [1]
Bulge symptoms and other associated prolapse symptoms are more significant than the anatomical changes that can be seen during gynecological examination
In a recent meta-analysis it was found that collagen type 3 alpha 1 (COL3A1) rs1800255 genotype AA was significantly associated with POP in an Asian and Dutch population compared with a reference genotype population [24]
Summary
Pelvic organ prolapse (POP) is a disturbing problem, which affect many women and their quality of life [1]. While studies presenting anatomical prolapse observed during gynecological examination describe the prevalence of POP up to 50%, other studies which involve only questionnaires of bothersome symptoms, describe much lower prevalence [2, 3]. The actual number of women that undergo intervention for POP seems to be similar to the prevalence described in telephonic surveys [5]. Many factors were described in association with POP, the relationship between the risk factors themselves is not clear and not always well understood. Weakness of the endopelvic fascia is the main factor in the etiology of POP and all the known risk factors cause weakness and damage of the fascia and may result in herniation of the organs and prolapse [6]
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