Demographic risk factors for pelvic organ prolapse: Do smoking, asthma, heavy lifting or family history matter?



      Our objective was to identify non-obstetric risk factors for pelvic organ prolapse in women attending a urogynecology clinic.

      Study design

      A retrospective study of 662 women referred for pelvic floor dysfunction between January 2017 and August 2018. Participants underwent a standardized interview, clinical exam including Pelvic Organ Prolapse Qualification (POP-Q) assessment, and four-dimensional transperineal ultrasound. They were questioned about smoking, asthma, heavy lifting and family history of pelvic organ prolapse, as well as prolapse symptoms. Significant clinical prolapse was defined as POP-Q stage ≥2 for anterior and posterior compartments and stage ≥1 for apical prolapse. Offline analysis of volume data was performed blinded against all other data. Statistical analysis included logistic regression with multivariable models adjusted for age, body mass index, vaginal parity, levator hiatal area and levator avulsion.


      Participating women were assessed at a mean age of 58 (SD 13.3) years with a mean body mass index of 28.93 kg/m2 (standard deviation 5.98). The vast majority were vaginally parous (88.2 %) with a median of two vaginal deliveries (range 0−7). Previous hysterectomy was reported by 29.3 % of women (n = 194) and previous prolapse repair by 17.2 % (n = 114). Past or current smoking was reported by 300 (45.6 %) women, 113 (17.2 %) reported asthma, 246 (37.6 %) heavy lifting and 186 (28.6 %) a family history of pelvic organ prolapse. Heavy lifting was associated with sonographic prolapse (odds ratio 1.71, 95 % confidence interval 1.2−2.4), confirmed on multivariable analysis (P = 0.046). Heavy lifting was positively associated with symptoms (P = 0.053) and clinical signs of pelvic organ prolapse (P = 0.056) on univariate analysis; however, this became non-significant on multivariable analysis. No associations were found for individual compartments except for a trend towards more posterior compartment prolapse with heavy lifting.


      Smoking, asthma and family history of prolapse were not found to be a significant risk factor for prolapse in our study population. Heavy lifting may be a potential risk factor, in particular for posterior compartment prolapse.


      4D-TPUS (four-dimensional transperineal ultrasound), POP (pelvic organ prolapse), POP-Q (pelvic organ prolapse quantification system), SD (standard deviation)


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