May 15, 2009 - Amersfoort, The Netherlands e-mail: [email protected]. M. C. P. Slieker-ten Hove .R. P. M. Steegers-Theunissen . C. W. Burger. Department of ...
Int Urogynecol J (2009) 20:1037–1045 DOI 10.1007/s00192-009-0902-1
ORIGINAL ARTICLE
The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population Marijke C. Ph. Slieker-ten Hove & Annelies L. Pool-Goudzwaard & Marinus J. C. Eijkemans & Regine P. M. Steegers-Theunissen & Curt W. Burger & Mark E. Vierhout
Received: 24 November 2008 / Accepted: 21 April 2009 / Published online: 15 May 2009 # The Author(s) 2009. This article is published with open access at Springerlink.com
Abstract Introduction and hypothesis In selected populations, pelvic organ prolapse (POP) was associated with bladder/bowel symptoms, but data on the general female population are lacking. Our aim was to obtain normative data on the prevalence of POP and pelvic floor dysfunction (PFD) symptoms and signs and to identify associations. Methods Validated questionnaires on POP and PFD (urogenital distress inventory, (UDI) and defaecation distress inventory (DDI)) were sent to a general population of 2,979
women (aged 45–85 years). Data were analysed using the Kruskal–Wallis test, chi square test and Spearman’s rank correlation coefficient. Results Response rate was 62.7%. Associations between POP stage and parity (0.002) and vaginal bulging (60–65 >65–70 >70 Overall
24 39 47 16 21 14 161
66 57 39 30 17 26 235
53 42 45 25 22 25 212
3 7 7 7 2 6 32
0 0 0 0 0 3 (4.1) 3 (0.5)
146 145 138 78 62 74 643
(16.4) (26.9) (34.1) (20.5) (33.9) (18.9) (25.0)
defined a positive POP symptom based on the question ‘do you have a feeling of something coming down in the vagina.’ Furthermore, their age group was age 15 to ≥65 years (28% were nulliparous and the number of deliveries in the parous group was unknown). They asked all the questions in a face-to-face interview, which may have led to different answers from those given on self-report questionnaires [23]. Prevalence of signs scored with the POPQ grading system In our general population, the percentage of women in the five ordinal POPQ stages (0–4) were 25%, 36.5%, 33%, 5% and 0.5%, respectively.
(45.2) (39.3) (28.3) (38.5) (27.4) (35.1) (36.5)
(36.3) (29.0) (32.6) (32.1) (35.5) (33.8) (33.0)
(2.1) (4.8) (5.1) (9.0) (3.2) (8.1) (5.0)
The prevalence of POP in a general population has only been determined using the POPQ grading system in a few studies. Our percentages in the five POP stages in the asymptomatic group 2, who did not report seeing and/or feeling vaginal bulging were comparable with those in the asymptomatic group in the study by Digesu et al. [24]. However, there was a difference in mean age (48 years), which indicates that age may not be responsible for this comparable result, which also can be concluded from our findings that age and POP stage were not significant associated. In contrast, the data on the symptomatic group differed, probably due the different choice of definition of ‘symptomatic’. In their symptomatic group, Digesu et al.
Table 3 Symptoms of pelvic floor disorders in the vaginal examination group versus the POPQ grading system in % n Urinary incontinence Urge urinary incontinence Stress urinary incontinence Mixed urinary incontinence Faecal incontinence Flatus Fluid stool Solid stool Obstructive micturition Difficulty emptying bladder Bladder not empty after micturition Obstructive defaecation False faecal urge Feeling of anal prolapse Manual evacuation of stool per vagina Manual evacuation of stool per anus Frequent straining during defaecation Vaginal bulging Constipation Pain Low abdominal During faecal urge During/after defaecation *p value
