The aetiology of prolapse

Abstract

Female pelvic organ prolapse is a common condition that is said to be multifactorial in aetiology. While a number of risk factors such as vaginal childbirth, obesity and ageing are commonly accepted, it is not clear as to how these risk factors affect the development of prolapse-that is, which pathophysiologic mechanisms are responsible for disease manifestation. Measures used in epidemiological studies, such as presentation for surgical treatment, are generally confounded by other conditions, and evidence is lacking for some of the most frequently quoted aetiological factors. In this paper, I will try to summarise the available evidence in order to separate hearsay and hypothesis from available research findings and to suggest a way forward for diagnosis and treatment.

Recent studies of genetic dysfunction in pelvic organ prolapse: The role of collagen defects

“…Furthermore, other factors, such as fascial fibre tearing, altered skeletal anatomy, reduced levator ani tone due to neuronal damage and levator ani avulsion following childbirth, may also contribute to prolapse development. 2,70,71 Levator avulsion defect is the traumatic muscle detachment of the puborectalis muscle from its insertion on the inferior pubic rami. This injury occurs in up to 36% of women 72 and has been shown to be associated with prolapse, particularly in the anterior and central compartment.…”

“…Aside from the traditional risk factors such as age, parity, vaginal childbirth and increased intra-abdominal pressure (ie obesity, chronic cough and constipation) 2 , the concept of a genetic tendency towards prolapse is becoming more apparent. For example, women with a positive family history of POP are more likely to develop prolapse compared to women with no family history (OR 2.58, 95% CI 2.12-3.15).…”

Rectal intussusception is associated with abnormal levator ani muscle structure and morphometry

“…If hiatal ballooning is associated with an increased risk of RI, would a reduction in hiatal area ameliorate or cure RI? This constitutes an area for future research, especially as such work would also have widespread repercussions in the treatment of vaginal prolapse [30].…”

Predictive Factors for Pelvic Organ Prolapse in Iranian Women’s, An Ordinal Logistic Approc

“…After Logistic Regression presence of at least one vaginal delivery, fetal macrosomia and positive family history for dystocia have reported as independent risk factors in POP [20]. Although several studies have confirmed the effect of increasing age on the incidence and severity of POP [9,[21][22][23][24], in a case study reported the third-degree uterine prolapse in 11-month-old infant [25].…”