Prolapse worsens with age, doesn't it?

BACKGROUND: Female pelvic organ prolapse is common and generally thought to worsen over time. This assumption has recently become less plausible, as the author and others have been able to show that mild to moderate pelvic organ descent is common in young, nulligravid women.

AIMS: To investigate the relationship between age and pelvic organ prolapse.

METHODS: The records of 1110 women seen for interview, clinical examination, urodynamics and ultrasound were evaluated in a retrospective study. Data were analysed to investigate the relationship between patient age at presentation and pelvic organ descent on clinical examination and ultrasound imaging.

RESULTS: After removal of 139 datasets of women with previous incontinence or prolapse surgery, 971 datasets remained. Mean age was 54 years (17-90), mean vaginal parity was 2.4 (0-12), with 31% complaining of prolapse. We found weak complex relationships between age and cystocele/rectocele staging, with a positive correlation to menopause and a negative relationship thereafter. This was confirmed on imaging findings, with regression showing an almost parabolic fitted line plot for cystocele and rectocele, but a near-linear curve for uterine prolapse. In nulliparous women, the positive relationship between age and cystocele in premenopausal women was still significant (P = 0.028), indicating that it is not explained by the confounding effect of child bearing.

CONCLUSIONS: Ageing seems to play a complex role in the aetiology and pathogenesis of pelvic organ prolapse. Our results contradict epidemiological studies showing age to be a major risk factor for pelvic reconstructive surgery and pelvic organ prolapse.