Pelvic floor prolapse has unclear relationship with urinary symptoms

By Joanna Lyford, Senior medwireNews Reporter

In women seeking treatment for pelvic floor problems, the severity of pelvic organ prolapse (POP) is not independently associated with lower urinary tract symptoms, a study by Spanish researchers has found.

The findings will be useful when counselling women about their options ahead of surgery for POP, say Montserrat Espuña-Pons (Hospital Clinic i Provincial, Barcelona) and colleagues writing in the European Journal of Obstetrics & Gynecology and Reproductive Biology.

The team studied 521 women referred to 35 urogynaecological clinics for assessment of pelvic floor dysfunction. On examination, 224 women were found to have anatomical POP, of whom 102 were classified as stage II and 122 as stage III or IV. The defect was located in the anterior vaginal compartment in the vast majority of women (82.14%) and in the posterior or central compartment in the remainder.

Compared with women without POP, those with POP tended to be older, were more likely to be postmenopausal and had a higher number of vaginal deliveries.

Also, based on Epidemiology of Prolapse and Incontinence Questionnaire (EPIQ) responses, women with POP were more likely than those without to experience a bulging sensation in the vagina, to have difficulties emptying their bladder, to experience leakage and nocturia and to report symptom-related limitations on their sexual activity.

Interestingly, the proportion of women with symptoms of overactive bladder (OAB) was very high overall but did not differ according to the severity of anatomic prolapse. Similarly, scores on questionnaires assessing urinary incontinence and OAB did not differ significantly according to prolapse severity.

Finally, multivariate analysis indicated that there were three significant independent predictors of prolapse severity: older age, vaginal bulge and symptom-related sexual limitations, with odds ratios of 1.04, 15.52 and 2.38, respectively.

The study authors say that the association between pelvic organ prolapse and urinary symptoms is complex and unclear. A very high proportion of women with prolapse report OAB symptoms, yet these symptoms are not independently associated with prolapse severity.

“Several theories have been proposed to explain the pathophysiology of OAB in women with POP, with the bladder outlet obstruction theory one of the most likely to be true”, they remark.

“In many cases OAB symptoms and signs seem to disappear after treatment; however, it is unclear which factors influence their persistence or disappearance. Therefore, it is difficult for clinicians to predict the result of POP surgery or management only with a vaginal pessary with reference to urinary symptoms”, the authors conclude.

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