Characteristics of pelvic organ prolapse in patients with connective tissue disorders

Objectives: Women with connective tissue disorders (CTD) have a higher risk of pelvic floor disorders (PFDs). The aim of this study was to determine characteristics of PFDs in women with CTD compared to women without CTD.

Methods: This matched cohort study included patients with documented pelvic organ prolapse (POP) seen in urogynecology clinics at two major referral centers from January, 2000 through July, 2022. Exposed were defined as having a diagnosis of Ehlers-danlos syndrome, hypermobility syndrome, stickler syndrome type 1, or Marfan’s syndrome. Unexposed were obtained using the Research Patient Data Registry (RPDR) hosted by MassGeneral Brigham at a ratio of 2:1 and were matched for age and race/ethnicity. RPDR output included diagnoses documented in the electronic medical record (EMR). We additionally collected demographic, physical exam data, and past surgical history. Analysis was conducted using Rstudio v2023.03.0+386 using Wilcoxon rank-sum or Fisher exact tests.

Results: A total of 319 women with POP were included, comprising 130 patients with CTD and 189 without CTD. CTD patients were non-significantly younger (mean age 44.5 vs 47.7, p = 0.07), had a significantly lower BMI (24.5 vs 26.9, p < 0.01), and were less likely to be married or partnered and more likely single (p < 0.01). CTD patients had been pregnant fewer times (1.6 vs 2.7, p < 0.01), had fewer vaginal deliveries, a lower rate of episiotomy, and a similar number of c-sections. They were less likely to have overactive bladder syndrome and urgency incontinence (23% vs 35%, p = 0.03) and stress urinary incontinence (35% vs 50%, p = 0.01) but were significantly more likely to have fecal incontinence (20% vs 7%, p < 0.01). They were also significantly more likely to have a diagnosis of rectal prolapse (23% vs 3%, p < 0.01). They were no more likely to have vaginitis but were more likely to have dyspareunia (22% vs 9%, p < 0.01). On exam, CTD patients were more likely to have levator ani tenderness (p < 0.01) but no difference in supine cough stress test or POP-Q measurements. Women with CTD were more likely to have other comorbidities, such as cardiac disease, POTS, GI disorders, and immune disorders (p < 0.01 for all).

Conclusions: Patients presenting with POP and CTD have a lower BMI and fewer obstetric-associated risk factors for prolapse compared to patients without CTD. However, there was no significant difference in prolapse stage between the two groups. Women with CTD were less likely to have associated urinary symptoms but more likely to have concurrent rectal prolapse and levator ani tenderness. Further research should be considered to investigate the impact of CTD on PFDs in women.