Racial Differences in Pelvic Organ Prolapse

Abstract

OBJECTIVE To compare the estimated prevalence of, risk factors for, and level of bother associated with subjectively reported and objectively measured pelvic organ prolapse in a racially diverse cohort. METHODS The Reproductive Risks for Incontinence Study at Kaiser 2 is a population-based cohort study of 2,270 middle-aged and older women. Symptomatic prolapse was self-reported, and bother was assessed on a five-point scale. In 1,137 women, prolapse was measured with the Pelvic Organ Prolapse Quantification (POP-Q) system. Multivariable logistic regression analysis was used to identify the independent association of prolapse and race while controlling for risk factors. RESULTS The participants’ mean (standard deviation) age was 55 (9) years, and 44% were white, 20% were African American, 18% were Asian American, and 18% were Latina or other race. Seventy-four women (3%) reported symptomatic prolapse. In multivariable analysis, the risk of symptomatic prolapse was higher in white (prevalence ratio 5.35, 95% confidence interval [CI] 1.89–15.12) and Latina (prevalence ratio 4.89, 95% CI 1.64–14.58) compared with African-American women. Race was not associated with report of moderate to severe bother. Degree of prolapse by POP-Q stage was similar across all racial groups; however, the risk of the leading edge of prolapse at or beyond the hymen was higher in white (prevalence ratio 1.40, 95% CI 1.02–1.92) compared with African-American women. CONCLUSION Compared with African-American women, Latina and white women had four to five times higher risk of symptomatic prolapse, and white women had 1.4-fold higher risk of objective prolapse with leading edge of prolapse at or beyond the hymen.

Objective comparison of subtotal vs. total abdominal hysterectomy regarding pelvic organ prolapse and urinary incontinence: a randomized controlled trial with 14-year follow-up

“…Surprisingly Thakar et al [11] reported that 12% had feelings of prolapse, so more women had symptoms than actual objective POP. In keeping with our finding, Whitcomb et al [25] found an overall rate of stage 2 POP of 66% in a population study of middle aged and elderly American women with and without hysterectomy. Moreover, they showed that Caucasian women were more likely to have a prolapse at or below the hymen than other races and were more likely to have symptomatic prolapse [25].…”

“…In keeping with our finding, Whitcomb et al [25] found an overall rate of stage 2 POP of 66% in a population study of middle aged and elderly American women with and without hysterectomy. Moreover, they showed that Caucasian women were more likely to have a prolapse at or below the hymen than other races and were more likely to have symptomatic prolapse [25]. Our trial consisted of Caucasian women only whereas Thakar et al [11] had a racially mixed trial population.…”

Prevalence of Symptomatic Pelvic Floor Disorders among Japanese Women

“…POP does not directly cause severe morbidity or mortality [3], although pelvic floor disorders (POP, urinary and fecal incontinence, voiding, and sexual dysfunction) has adverse effects on daily life [4], health status [5], and quality of life [3,4,6]. POP has numerous risk factors, including parity [7][8][9], older age [7,10,11], obesity [12,13], hysterectomy [14], chronic medical conditions [7], heavy lifting [15], constipation [5], smoking status [16,17], employment [18], and race/ethnicity [7,19]. Furthermore, >200,000 surgeries are performed each year in the US to treat POP, which is the most common indication for hysterectomy among middle-aged women [5,20], and the annual economic burden of POP is >$1 billion in the US [5,10].…”

Pelvic floor disorders: what’s the best test?

“…Conclusions show that the etiology is multifactorial combining epidemiological factors like female gender, old age, high IBM, and nutritional deficits that lead to biomechanical abnormalities in connective tissue compositions due to hormonal deficiencies and irregular tissue metabolism with obstetrical/ gynecological, gastrointestinal, and psychological risk factors (Fig. 5) [8][9][10][11][12][13][14][15][16].…”