Prevalence and incidence of symptoms associated with POP by leading edge of the prolapse

Objectives: To explore the relationship between degree of prolapse as defined by leading edge and the prevalence and incidence of patient reported symptoms including pain, genitourinary, gastrointestinal, and sexual function.

Methods: 205 new patients presenting to academic urogynecology centers in the US, UK, and Chile for POP evaluation were enrolled. The study was approved by each institution’s IRB. Subjects were surveyed about pain, GU, GI and sexual function via a questionnaire modified from previously validated questionnaires. Only subjects who reported a symptom as “somewhat”, “a moderate amount” or “a lot” in terms of bother were classified as having the symptom as present. Additionally, participants were queried if the symptom’s onset concurred with the POP and whether they perceived the symptom was worsened by their POP.

Results: When examined subjects using the POP-Q exam, 126 subjects had a leading edge of 0 to +2cm, 68 had a leading edge of +3 to +5cm, and 10 had a leading edge > +5cm. Regardless of leading edge of the prolapse, approximately half of subjects reported urinary frequency and urgency with 20% attributing the incidence to POP. The prevalence and incidence of bowel emptying were approximately one third and 20% of subjects for each subgroup. Subjects reported increasing difficulty voiding with increasing stage of POP and the POP worsened their symptom. For pelvic pain, subjects with mild to moderate prolapse reported about 40% prevalence and nearly 70% incidence of pelvic pain. Only one subject with a leading edge > +5cm had pelvic pain and reported that the onset coincided with timing of POP. The prevalence of back pain tended to increase with increasing degree of POP, however, the incidence of back pain coinciding with the onset of POP was low and few subjects attributed worsening back pain to their POP. Dyspareunia increased with decreasing extent of prolapse.

Conclusions: Among all of the symptoms queried only the presence of voiding difficulty increased with progression of POP stage, with more advanced stages associated with worsening impact of POP on voiding function. The degree of POP does not appear to influence the prevalence and incidence of urinary frequency, urgency and leakage nor fecal incontinence and incomplete bowel emptying. The prevalence of back pain increased with increasing stage of prolapse but few patients correlated the onset of their back pain with POP onset. Overall, the degree of prolapse did not seem to be correlated with degree of bother of patients’ symptoms, with the exception of voiding difficulty, which may ultimately affect how patients are counseled regarding progression of POP and symptom worsening.