The prevalence of pelvic organ prolapse is one of my favorite things to talk about. Prolapse is SO common, and not enough people know that! Here are some statistics associated with the risk of prolapse (Weintraub 2020):
3-50% of people with vulvas have prolapse
50% of people with vulvas who have been pregnant have prolapse, as do 50% of menopausal people
Prolapse increases with age, but prolapse can even be seen in people in their 20s
These statistics illustrate why it can get a little confusing when talking about prolapse, because different studies define prolapse differently. The biggest differentiator between the studies are whether or not the participant has symptoms. Basically, is the study looking at people with symptoms of prolapse like pelvic pressure/heaviness, or difficulty emptying bladder or bowels? Or is the study relying upon an actual diagnosis by a medical professional from completing a vaginal examination?
The prevalence of prolapse that does NOT cause symptoms is actually much higher than the prevalence of prolapse that causes symptoms. Some studies will show prolapse occurs in only 3-10% of people with vulvas who have symptoms (ACOG & Abrams), while others show a 94% rate of prolapse if you are talking about grade 1 prolapses that do not cause any symptoms at all (Braekken 2015). In fact, I want to highlight a joint statement by the American College of Obstetricians and Gynecologists (ACOG) and the American Urogynecologic Society (AUGS):
“Mild descent of the pelvic organs is common and should not be considered pathologic. Pelvic organ prolapse should only be considered a problem if it is causing prolapse symptoms (ie, pressure with or without a bulge) or sexual dysfunction or if it is disrupting normal lower urinary tract or bowel function.”
So, if you have a mild prolapse especially (grade 1), try not to get too worried! If you need a review on the grades or prolapse, please check out my article titled “Prolapse is Confusing!”
What Types of Prolapse are Most Common?
This is also where the literature is really interesting, and shows more truths that are not discussed often. In people who are diagnosed with prolapse, these are the rates of the different types of prolapse seen: (Abrams 2017)
Cystocele (bladder) 16-25%
Rectum (rectocele) 13-19%
Uterus 5-14%
And of those, the vast majority have grades 1 or 2 prolapse. But guess what…..65% of people with prolapse have some grade of prolapse of all 3 organs.
That’s right—unfortunately when one organ starts to fall, the rest tend to come with it. This is especially true of the uterus. The uterus and cervix are kind of like the roof of the house of your vagina. And once the roof starts to fall in, it tends to take the walls with it.
What About Postpartum Prolapse?
This is also incredibly common, and again not discussed often. Durnea 2014 found these rates in a smaller study of 202 people with vulvas who were one year postpartum after their FIRST baby:
89% had uterine prolapse
90% had cystocele
70% had rectocele
And again, the majority of these study participants had prolapse in multiple compartments. Plus, 80% had no symptoms as the majority of these were grades 1 and 2. And, the majority of these participants also were young—78% were under the age of 34.
The study didn’t do any long-term follow-up, so my suspicion is that these conditions likely improved over time as the demands of childcare were less, and the participants returned to their pre-partum levels of strength and activity.
What Are the Risk Factors for Prolapse?
This is another one I love to talk about, because it helps to realize that developing prolapse is largely out of an individual person’s control. The main “cause” of prolapse is a weakening of the fascia and ligaments that help hold up your internal organs. Your pelvic floor strength, or lack thereof, can contribute to prolapse, but typically is not the primary problem.
Here is a non-exhaustive list of risk factors:
Having a vagina is number one (a larger space in the pelvis required for childbirth also means more space for organs to change position)
Being pregnant, especially more than once (parity)
Vaginal childbirth, especially pushing more than 2-3 hours or the need for forceps/vacuum
Genetics/family history
Connective tissue disorders (joint hypermobility)
Menopause specifically, as well as simply aging
Pelvic trauma/injury
Heavy lifting
Chronic constipation/straining
Lung disorders or chronic coughing
Poor nutrition
Smoking
Higher body weight/mass due to pressure placed on the internal organs (please note: in the graphic it does say “obesity,” which is not our choice of words)
Race/ethnicity
Hysterectomy
Hopefully this helps pull back the curtain a bit on why you may have prolapse (if you do), and help you realize that it’s not your fault. Make sure to check out the next article that discusses intra-abdominal pressure, which is really the link behind all of these issues, and is the key to avoiding making your prolapse worse!
References:
Abrams,P, Cardozo, L, Wagg, A, Wein, A. (Eds) Incontinence 6th Edition (2017). ICI-ICS. International Continence Society, Bristol UK, ISBN: 978-0956960733.
American College of Obstetricians and Gynecologists and the American Urogynecologic Society, & INTERIM UPDATE: This Practice Bulletin is updated as highlighted to reflect the US Food and Drug Administration order to stop the sale of transvaginal synthetic mesh products for the repair of pelvic organ prolapse. (2019). Pelvic Organ Prolapse. Female pelvic medicine & reconstructive surgery, 25(6), 397–408. https://doi.org/10.1097/SPV.0000000000000794
Braekken, I. H., Majida, M., Ellström Engh, M., & Bø, K. (2015). Can pelvic floor muscle training improve sexual function in women with pelvic organ prolapse? A randomized controlled trial. The journal of sexual medicine, 12(2), 470–480. https://doi.org/10.1111/jsm.12746
Durnea, C. M., Khashan, A. S., Kenny, L. C., Durnea, U. A., Smyth, M. M., & O’Reilly, B. A. (2014). Prevalence, etiology and risk factors of pelvic organ prolapse in premenopausal primiparous women. International urogynecology journal, 25(11), 1463–1470. https://doi.org/10.1007/s00192-014-2382-1
Weintraub, A. Y., Glinter, H., & Marcus-Braun, N. (2020). Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse. International braz j urol : official journal of the Brazilian Society of Urology, 46(1), 5–14. https://doi.org/10.1590/S1677-5538.IBJU.2018.0581
Photo by Joel Muniz on Unsplash