Pelvic Organ Prolapse
Pelvic organ prolapse is a major cause of morbidity affecting up to 50% of parous women over 50 years of age.[60] In the USA, approximately 300,000 inpatient surgical procedures for pelvic organ prolapse are performed each year.[42] Surgery remains the mainstay of treatment for pelvic organ prolapse, although conservative management, such as pessaries, are still in widespread use.[61]
The etiology of pelvic organ prolapse is almost certainly multifactorial,[62] and several predisposing factors are suggested in the literature. Jelovsek et al. propose that established risk factors for pelvic organ prolapse are: vaginal delivery, advancing age and obesity.[25] Other possible predisposing factors include obstetrical factors such as parity,[24,63–65] increased fetal weight[60,66] and instrumental delivery,[63] as well as occupations that entail heavy lifting,[67] chronic constipation,[68] connective-tissue disorders[69] and genetic factors.[70]
Most clinicians would agree that hysterectomy is indeed a risk factor for pelvic organ prolapse, but only in recent years has robust epidemiological evidence to support this notion been presented.[24,26,27] In a nested case–control study by Dällenbach et al. the incidence of prolapse for which there was a surgical correction after hysterectomy was 1.3 per 1000 women-years.[71] Vaginal hysterectomy, compared with abdominal hysterectomy, did not increase the risk for pelvic organ prolapse requiring surgical correction. In the Oxford Family Planning Association Study, the corresponding risk of pelvic organ prolapse subsequent to hysterectomy was 3.6 per 1000 women-years.[24]
Aging Health. 2013;9(2):179-187. © 2013 Future Medicine Ltd.
