Top

International Urogynecology Journal

Published in:

01-08-2018 | Original Article

Obesity: how much does it matter for female pelvic organ prolapse?

Authors: Natharnia Young, Ixora Kamisan Atan, Rodrigo Guzman Rojas, Hans Peter Dietz

Published in: International Urogynecology Journal | Issue 8/2018

Abstract

Introduction and hypothesis

The objective was to determine the association between body mass index (BMI) and symptoms and signs of female pelvic organ prolapse (POP).

Methods

An observational cross-sectional study of 964 archived datasets of women seen for symptoms and signs of lower urinary tract and pelvic organ dysfunction between September 2011 and February 2014 at a tertiary urogynaecology centre in Australia was carried out. An in-house standardised interview, the International Continence Society Pelvic Organ Prolapse Quantification (ICS POP-Q) and 4-D translabial ultrasound, followed by analysis of ultrasound volumes for pelvic organ descent and hiatal area on Valsalva, were performed, blinded against other data.

Results

There is a positive association between BMI and posterior compartment prolapse on clinical examination and ultrasound imaging, but not for the anterior and central compartments. There was no association with prolapse symptom bother and a negative association with symptoms of prolapse.

Conclusions

In this observational study, we found a strong association between all tested measures of posterior compartment descent and BMI, both clinical and on imaging.

Glazener C, Elders A, Macarthur C, Lancashire RJ, Herbison P, Hagen S, et al. Childbirth and prolapse: long-term associations with the symptoms and objective measurement of pelvic organ prolapse. Br J Obstet Gynaecol. 2013;120(2):161–8.CrossRef

Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. Br J Obstet Gynaecol. 2013;120(2):152–60.CrossRef

Smith FJ, Holman CDJ, Moorin RE, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010;116(5):1096–100.CrossRefPubMed

Barber M, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J. 2013;24(11):1783–90.CrossRefPubMed

Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JOL, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.CrossRefPubMed

Dietz HP. The aetiology of prolapse. Int Urogynecol J. 2008;19(10):1323–9.CrossRef

Vergeldt TF, Weemhoff M, IntHout J, Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015;26(11):1559–73.CrossRefPubMedPubMedCentral

Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the women’s health initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186(6):1160–6.CrossRefPubMed

Swift S, Woodman P, O’Boyle A, Kahn M, Valley M, Bland D, et al. Pelvic organ support study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol. 2005;192(3):795–806.CrossRefPubMed

10.

Wu JM, Hundley AF, Fulton RG, Myers ER. Forecasting the prevalence of pelvic floor disorders in U.S. women: 2010 to 2050. Obstet Gynecol. 2009;114(6):1278–83.CrossRefPubMed

11.

Washington BB, Erekson EA, Kassis NC, Myers DL. The association between obesity and stage II or greater prolapse. Am J Obstet Gynecol. 2010;202(5):503.e1–4.CrossRef

12.

Anonymous. Overweight and obesity. Commonwealth of Australia; Australian Bureau of Statistics; http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/bySubject/4338.0~2011-13~MainFeatures~Overweightandobesity~10007

13.

Ulrich D, Guzman Rojas R, Dietz H, Mann K, Trutnovsky G. Use of a visual analog scale for evaluation of bother from pelvic organ prolapse. Ultrasound Obstet Gynecol. 2014;43(6):693–7.CrossRefPubMed

14.

Dietz HP. Ultrasound imaging of the pelvic floor. II: Three-dimensional or volume imaging. Ultrasound Obstet Gynecol. 2004;23(6):615–25.CrossRefPubMed

15.

Ornö A, Dietz HP. Levator co-activation is a significant confounder of pelvic organ descent on Valsalva maneuver. Ultrasound Obstet Gynecol. 2007;30(3):346–50.CrossRefPubMed

16.

Dietz HP, Mann KP. What is clinically relevant prolapse? An attempt at defining cutoffs for the clinical assessment of pelvic organ descent. Int Urogynecol J. 2014;25(4):451–5.CrossRefPubMed

17.

Dietz H, Haylen B, Broome J. Ultrasound in the quantification of female pelvic organ prolapse. Ultrasound Obstet Gynecol. 2001;18(5):511–4.CrossRefPubMed

18.

Shek KL, Dietz HP. What is abnormal uterine descent on translabial ultrasound? Int Urogynecol J. 2015;26(12):1783–7.CrossRefPubMed

19.

Dietz HP, Steensma AB. Posterior compartment prolapse on two-dimensional and three-dimensional pelvic floor ultrasound: the distinction between true rectocele, perineal hypermobility and enterocele. Ultrasound Obstet Gynecol. 2005;26(1):73–7.CrossRefPubMed

20.

World Health Organisation. Obesity: preventing and managing the global epidemic. 2000. http://apps.who.int/bmi/index.jsp?introPage=intro_3.html. Accessed 19 October 2016.

21.

Braverman M, Turel F, Friedman T, Kamisan Atan I, Dietz HP. Does patient posture affect the sonographic evaluation of pelvic organ prolapse? Ultrasound Obstet Gynecol. 2016;48(Suppl 1):8.

22.

Handa VL, Garrett E, Hendrix S, Gold E, Robbins J. Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol. 2004;190(1):27–3.CrossRefPubMed

23.

Whitcomb EL, Lukacz ES, Lawrence JM, Nager CW, Luber KM. Prevalence and degree of bother from pelvic floor disorders in obese women. Int Urogynecol J. 2009;20(3):289–94.CrossRef

24.

Noblett KL, Jensen JK, Ostergard DR. The relationship of body mass index to intra-abdominal pressure as measured by multichannel Cystometry. Int Urogynecol J. 1997;8(6):323–6.CrossRef

25.

Dietz HP, Simpson JM. Levator trauma is associated with pelvic organ prolapse. Br J Obstet Gynaecol. 2008;115:979–84.CrossRef

26.

Orejuela F, Shek KL, Dietz HP. The time factor in the assessment of prolapse and levator ballooning. Int Urogynecol J. 2012;23(2):175–8.CrossRefPubMed

27.

Mulder F, Shek KL, Dietz HP. The pressure factor in the assessment of pelvic organ mobility. Aust NZ J Obstet Gynaecol. 2012;52:282–5.CrossRef

Title: Obesity: how much does it matter for female pelvic organ prolapse?
Authors: Natharnia Young
Ixora Kamisan Atan
Rodrigo Guzman Rojas
Hans Peter Dietz
Publication date: 01-08-2018
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 8/2018
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-017-3455-8

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Obesity: how much does it matter for female pelvic organ prolapse?

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2018

How do patients and surgeons decide on uterine preservation or hysterectomy in apical prolapse?

Laparoscopic high uterosacral ligament suspension: an alternative route for a traditional technique

Does transition of urinary incontinence from one subtype to another represent progression of the disease?

Quality of life following vaginal reconstructive versus obliterative surgery for treating advanced pelvic organ prolapse

Manchester–Fothergill procedure versus vaginal hysterectomy with uterosacral ligament suspension: an activity-based costing analysis

Quo vadis, vaginal mesh in pelvic organ prolapse?