Obesity and pelvic organ prolapse

Pelvic Organ Prolapse (POP) prevalence rates range from 10% in younger women and up to 50% in postmenopausal women.

Nearly 1 in 10 women will undergo surgical correction for POP in their lifetime.

This can be defined as descend into the vaginal space prolapse of >1 intrapelvic organ (uterus, bladder, rectum, and the urethra), presumably due to deficiencies in the pelvic support system that normally provides sustained support.

There are many known and unknown variables that affect the severity of POP and its symptoms.

Epidemiological studies have identified age, race, parity, size of infant, and body mass index (BMI) as independent risk factors for POP.

Aging and parity have been most consistently associated with POP; however, these factors are not modifiable. Obesity is a modifiable risk factor that may be influenced on a population level to reduce the public health and economic burden of POP.

As the population ages, the prevalence of POP is likely to increase, and more women will undergo surgical procedures to treat prolapse.

These two factors—increasing obesity rates and the aging population—will most likely increase the rates of POP beyond what is predicted.

Data from published cross-sectional and prospective studies suggest that being overweight or obese is associated with prevalent and incident POP as well as progression of POP; however, few studies have evaluated the impact of weight loss on subjective or objective POP or symptom severity

POP is defined as the descent of the anterior vaginal wall, the posterior vaginal wall and/or the apex of the vagina (cervix or vault after hysterectomy).

For clinical and research purposes, the Pelvic Organ Prolapse Quantification (POP-Q) scale is used for an objective quantification of degree of the prolapse.

The prevalence of POP varies depending on the used definition. The subjective diagnosis of POP is mostly defined by the sensation of vaginal bulging. The reported prevalence range is 6%–11%. The subjective presence of a POP is strongly associated with a prolapse beyond the level of the hymen.

Risk factors for developing a POP can be divided into obstetric, lifestyle, comorbidity, nonmodifiable (e.g., age), social, pelvic floor, and surgical factors. Parity and aging are the strongest risk factors of POP. The most important lifestyle factor is a higher BMI.

The most probable mechanism of POP development among obese women is the increase in intraabdominal pressure that causes weakening of pelvic floor muscles and fascia. However, studies evaluating the association between obesity and POP have reported inconsistent conclusions.

Study showed symptomatic POP increased by 3% with each unit increase in current BMI. Recent published systematic review and meta-analysis showed that, compared with normal-weight women, women in the overweight and obese categories had risk ratios of at least 1.36 (95% CI, 1.20–1.53) and 1.47 (95% CI, 1.35–1.59), respectively, of developing POP.

A large US study that analysed data from 16,608 women showed progression of POP with increasing body weight. The excess risks for anterior vaginal prolapse were 32% and 48% in overweight and obese women, respectively, for posterior prolapse 37% and 58%, and for uterine prolapse it was 43% and 69%. However, weight loss did not significantly reduce degree of POP and suggested that damage to the pelvic floor associated with obesity may be irreversible.