Objective: Pelvic organ prolapse is an emerging public health problem affecting adult women of all ages with a negative impact on social, physical well-being, and psychological. Its presents several challenges in countries with low resources. This literature review aims to examine POP in its epidemiological aspects, risk factors, and staging by taking up the challenges associated with low-resource settings and identifying some avenues for future research. Methods: We searched the PubMed, Google Scholar, and Scopus databases. The other studies were identified by checking the secondary references in the original citation. We have collected studies on adult women published in English for the last 30 years. In total, 71 articles were read. We excluded studies from all newspaper articles, Studies presenting co-morbidities (fistulas, cervical cancer, pregnancy), those evaluating treatment, letters, comments, case reports, practice guidelines, news, historical articles, legal cases, published erratum, and congresses. Results: 16 studies examining the epidemiology have been identified with 11 in countries defined by the World Bank as limited or intermediate resources. 18 on risk factors whose 10 in countries with limited or intermediate resources, 10 on staging and 27 on physiopathology. Conclusion: POP affects the young more in low-resource settings. Its prevalence remains underestimated for several reasons. Several risk factors found are the same as those of women in countries with a high standard of living. However, there are some specific risk factors for these resource-limited settings.
References
[1]
Horst, W., do Valle, J.B., Silva, J.C. and Gascho, C.L.L. (2017) Pelvic Organ Prolapse: Prevalence and Risk Factors in a Brazilian Population. International Urogynecology Journal, 28, 1165-1170. https://doi.org/10.1007/s00192-016-3238-7
[2]
Kerkhof, M.H., Hendriks, L. and Brölmann, H.A.M. (2009) Changes in Connective Tissue in Patients with Pelvic Organ Prolapse—A Review of the Current Literature. International Urogynecology Journal, 20, 461-474. https://doi.org/10.1007/s00192-008-0737-1
[3]
Lince, S.L., Van Kempen, L.C., Vierhout, M.E. and Kluivers, K.B. (2012) A Systematic Review of Clinical Studies on Hereditary Factors in Pelvic Organ Prolapse. International Urogynecology Journal, 23, 1327-1336. https://doi.org/10.1007/s00192-012-1704-4
[4]
Vergeldt, T.F.M., Weemhoff, M., IntHout, J. and Kluivers, K.B. (2015) Risk Factors for Pelvic Organ Prolapse and Its Recurrence: A Systematic Review. International Urogynecology Journal, 26, 1559-1573. https://doi.org/10.1007/s00192-015-2695-8
[5]
Devkota, H.R., Sijali, T.R., Harris, C., Ghimire, D.J., Prata, N. and Bates, M.N. (2020) Bio-Mechanical Risk Factors for Uterine Prolapse among Women Living in the Hills of West Nepal: A Case-Control Study. Women’s Heal, 16. https://doi.org/10.1177/1745506519895175
[6]
Masenga, G.G., Shayo, B.C. and Rasch, V. (2018) Prevalence and Risk Factors for Pelvic Organ Prolapse in Kilimanjaro, Tanzania: A Population Based Study in Tanzanian Rural Community. PLOS ONE, 13, e195910. https://doi.org/10.1371/journal.pone.0195910
[7]
Henok, A. (2017) Prevalence and Factors Associated with Pelvic Organ Prolapse among Pedestrian Back-Loading Women in Bench Maji Zone. Ethiopian Journal of Health Sciences, 27, 263-272. https://doi.org/10.4314/ejhs.v27i3.8
[8]
Akter, F., Gartoulla, P., Oldroyd, J. and Islam, R.M. (2016) Prevalence of and Risk Factors for, Symptomatic Pelvic Organ Prolapse in Rural Bangladesh: A Cross-Sectional Survey Study. International Urogynecology Journal, 27, 1753-1759. https://doi.org/10.1007/s00192-016-3038-0
[9]
Henn, E.W., Juul, L. and van Rensburg, K. (2015) Pelvic Organ Prolapse in the Neonate: Report of Two Cases and Review of the Literature. International Urogynecology Journal, 26, 613-615. https://doi.org/10.1007/s00192-014-2539-y
[10]
Auwad, W., Freeman, R.M. and Swift, S. (2004) Is the Pelvic Organ Prolapse Quantification System (POPQ) Being Used? A Survey of Members of the International Continence Society (ICS) and the American Urogynecologic Society (AUGS). International Urogynecology Journal, 15, 324-327.
[11]
de Barros Moreira Lemos N.L., Auge, A.P.F., Lunardelli, J.L., Carramão, S.D.S., Faria, A.L.A. and Aoki, T. (2008) Validation of the Pelvic Organ Prolapse Quantification Index (POP-Q-I): A Novel Interpretation of the POP-Q System for Optimization of POP Research. International Urogynecology Journal, 19, 995-997. https://doi.org/10.1007/s00192-007-0556-9
[12]
Liang, C.C., Tseng, L.H., Horng, S.G., Lin, I.W. and Chang, S.D. (2007) Correlation of Pelvic Organ Prolapse Quantification System Scores with Obstetric Parameters and Lower Urinary Tract Symptoms in Primiparae Postpartum. International Urogynecology Journal, 18, 537-541. https://doi.org/10.1007/s00192-006-0195-6
[13]
World Bank (2020) World Bank Country and Lending Groups—Country Classification. The World Bank. https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups.consulted on 05.10.2021
[14]
Haylen, B.T., De Ridder, D., Freeman, R.M., Swift, S.E., Berghmans, B., Lee, J., et al. (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction. Neurourology and Urodynamics, 29, 4-20. https://doi.org/10.1002/nau.20798
[15]
Swift, S., Woodman, P., O’Boyle, A., Kahn, M., Valley, M., Bland, D., et al. (2005) Pelvic Organ Support Study (POSST): The Distribution, Clinical Definition and Epidemiologic Condition of Pelvic Organ Support Defects. American Journal of Obstetrics & Gynecology, 192, 795-806. https://doi.org/10.1016/j.ajog.2004.10.602
[16]
Weber, A.M., Abrams, P., Brubaker, L., Cundiff, G., Davis, G., Dmochowski, R.R., et al. (2001) The Standardization of Terminology for Researchers in Female Pelvic Floor Disorders. International Urogynecology Journal, 12, 176-186. https://doi.org/10.1007/PL00004033
[17]
Swift, S. (2005) Pelvic Organ Prolapse: Is It Time to Define It? International Urogynecology Journal, 16, 425-427. https://doi.org/10.1007/s00192-005-1372-8
[18]
Mant, J., Painter, R. and Vessey, M. (1997) Epidemiology of Genital Prolapse: Observations from the Oxford Family Planning Association Study. BJOG, 104, 579-585. https://doi.org/10.1111/j.1471-0528.1997.tb11536.x
[19]
Scherf, C., Morison, L., Fiander, A., Ekpo, G. and Walraven, G. (2002) Epidemiology of Pelvic Organ Prolapse in Rural Gambia, West Africa. BJOG, 109, 431-436. https://doi.org/10.1111/j.1471-0528.2002.01109.x
[20]
Walker, G.J.A. and Gunasekera, P. (2011) Pelvic Organ Prolapse and Incontinence in Developing Countries: Review of Prevalence and Risk Factors. International Urogynecology Journal, 22, 127-135. https://doi.org/10.1007/s00192-010-1215-0
[21]
Elbiss, H.M., Osman, N. and Hammad, F.T. (2015) Prevalence, Risk Factors and Severity of Symptoms of Pelvic Organ Prolapse among Emirati Women. BMC Urology, 15, Article No. 66. https://doi.org/10.1186/s12894-015-0062-1
[22]
Rortveit, G., Brown, J.S., Thom, D.H., van den Eeden, S.K., Creasman, J.M., et al. (2007) Symptomatic Pelvic Organ Prolapse Prevalence and Risk Factors in a Population-Based, Racially Diverse Cohort. Obsterices and Gynecology, 109, 1396-1403. https://doi.org/10.1097/01.AOG.0000263469.68106.90
[23]
Islam, R.M., Oldroyd, J., Karim, M.N., Hossain, S.M., Md Emdadul Hoque, D., Romero, L., et al. (2017) Systematic Review and Meta-Analysis of Prevalence of and Risk Factors for, Pelvic Floor Disorders in Community-Dwelling Women in Low and Middle-Income Countries: A Protocol Study. BMJ Open, 7, e015626. https://doi.org/10.1136/bmjopen-2016-015626
[24]
Megabiaw, B., Adefris, M., Rortveit, G., Degu, G., Muleta, M., Blystad, A., et al. (2013) Pelvic Floor Disorders among Women in Dabat District, Northwest Ethiopia: A Pilot Study. International Urogynecology Journal, 24, 1135-1143. https://doi.org/10.1007/s00192-012-1981-y
[25]
Weintraub, A.Y., Glinter, H. and Marcus-Braun, N. (2020) Narrative Review of the Epidemiology, Diagnosis and Pathophysiology of Pelvic Organ Prolapse. International Brazilian Journal of Urology, 46, 5-14. https://doi.org/10.1590/s1677-5538.ibju.2018.0581
[26]
Woodman, P.J., Swift, S.E., O’Boyle, A.L., Valley, M.T., Bland, D.R., Kahn, M.A. and Schaffer, J.I. (2006) Prevalence of Severe Pelvic Organ Prolapse in Relation to Job Description and Socioeconomic Status: A Multicenter Cross-Sectional Study. International Urogynecology Journal, 17, 340-345. https://doi.org/10.1007/s00192-005-0009-2
[27]
Akmel, M. and Segni, H. (2012) Pelvic Organ Prolapse in Jimma University Specialized Hospital, Southwest Ethiopia. Ethiopian Journal of Health Sciences, 22, 85-92.
[28]
Kayembe, A.T., Muela, A.M., Baleka, A.M., Mushengezi, D.S., Baleka, A.M. and Sengeyi, D. (2020) Article Case series Genital Prolapse: Epidemiology, Clinic and Therapeutic at Saint Joseph Hospital of Kinshasa. The Pan African Medical Journal, 37, Article 196. https://doi.org/10.11604/pamj.2020.37.196.21818
[29]
McLennan, M.T., Harris, J.K., Kariuki, B. and Meyer, S. (2008) Family History as a risk Factor for Pelvic Organ Prolapse. International Urogynecology Journal, 19, 1063-1069. https://doi.org/10.1007/s00192-008-0591-1
[30]
Bump, R.C. and Norton, P.A. (1998) Epidemiology and Natural History of Pelvic Floor Dysfunction. Obstetrics and Gynecology Clinics of North America, 25, 723-746. https://doi.org/10.1016/S0889-8545(05)70039-5
[31]
Tegerstedt, G., Maehle-Schmidt, M., Nyrén, O. and Hammarström, M. (2005) Prevalence of Symptomatic Pelvic Organ Prolapse in a Swedish Population. International Urogynecology Journal, 16, 497-503. https://doi.org/10.1007/s00192-005-1326-1
[32]
Abdool, Z. and Swart, P. (2016) Symptomatic Pelvic Organ Prolapse: Experience at a Tertiary Urogynaecology Clinic. The South African Journal of Obstetrics and Gynaecologyis, 22, 18-20. https://doi.org/10.7196/sajog.1038
[33]
Hendrix, S.L., Clark, A., Nygaard, I., Aragaki, A., Barnabei, V. and Mc Tiernan, A. (2002) Pelvic Organ Prolapse in the Women’s Health Initiative: Gravity and Gravidity. American Journal of Obstetrics & Gynecology, 186, 1160-1166. https://doi.org/10.1067/mob.2002.123819
[34]
Durnea, C.M., Khashan, A.S., Kenny, L.C., Durnea, U.A., Smyth, M.M. and O’Reilly, B.A. (2014) Prevalence, Etiology and Risk Factors of Pelvic Organ Prolapse in Premenopausal Primiparous Women. International Urogynecology Journal, 25, 1463-1470. https://doi.org/10.1007/s00192-014-2382-1
[35]
Chiaffarino, F., Chatenoud, L., Dindelli, M., Meschia, M., Buonaguidi, A., Amicarelli, F., et al. (1999) Reproductive Factors, Family History, Occupation and Risk of Urogenital Prolapse. European Journal of Obstetrics & Gynecology and Reproductive Biology, 82, 63-67. https://doi.org/10.1016/S0301-2115(98)00175-4
[36]
Forner, L.B., Beckman, E.M. and Smith, M.D. (2020) Symptoms of Pelvic Organ Prolapse in Women Who Lift Heavy Weights for Exercise: A Cross-Sectional Survey. International Urogynecology Journal, 31, 1551-1558. https://doi.org/10.1007/s00192-019-04163-w
[37]
Yu, C.H., Chan, S.S.C., Cheung, R.Y.K. and Chung, T.K.H. (2018) Prevalence of Levator Ani Muscle Avulsion and Effect on Quality of Life in Women with Pelvic Organ Prolapse. International Urogynecology Journal, 29, 729-733. https://doi.org/10.1007/s00192-017-3454-9
[38]
Dietrich, W., Elenskaia, K., Obermayr, E., Horvat, R., Mayerhofer, K., Umek, W., Zeillinger, R. and Hanzal, E. (2012) Relaxin and Gonadal Steroid Receptors in Uterosacral Ligaments of Women with and without Pelvic Organ Prolapse. International Urogynecology Journal, 23, 495-500. https://doi.org/10.1007/s00192-011-1615-9
[39]
Chen, H.Y., Chung, Y.W., Lin, W.Y., Chen, W.C., Tsai, F.J. and Tsai, C.H. (2008) Estrogen Receptor Alpha Polymorphism Is Associated with Pelvic Organ Prolapse Risk. International Urogynecology Journal, 19, 1159-1163. https://doi.org/10.1007/s00192-008-0603-1
[40]
Bai, S.W., Chung, D.J., Yoon, J.M., Shin, J.S., Kim, S.K. and Park, K.H. (2005) Roles of Estrogen Receptor, Progesterone Receptor, p53 and p21 in Pathogenesis of Pelvic Organ Prolapse. International Urogynecology Journal, 16, 492-496. https://doi.org/10.1007/s00192-005-1310-9
[41]
Ruiz-Zapata, A.M., Kerkhof, M.H., Zandieh-Doulabi, B., Brölmann, H.A.M., Smit, T.H. and Helder, M.N. (2013) Fibroblasts from Women with Pelvic Organ Prolapse Show Differential Mechanoresponses Depending on Surface Substrates. International Urogynecology Journal, 24, 1567-1575. https://doi.org/10.1007/s00192-013-2069-z
[42]
Ntakwinja, M., Borazjani, A., Vodusek, Z., Tambwe, A.M. and Mukwege, D. (2021) Surgical Management of Pelvic Organ Prolapse in a High-Volume Resource-Limited Setting. International Journal of Gynercology & Obstetrics, 156, 145-150. https://onlinelibrary.wiley.com/doi/10.1002/ijgo.13684 https://doi.org/10.1002/ijgo.13684
[43]
Cheung, R.Y.K., Chan, S.S.C., Shek, K.L., Chung, T.K.H. and Dietz, H.P. (2019) Pelvic Organ Prolapse in Caucasian and East Asian Women: A Comparative Study. Ultrasound in Obstetrics & Gynecology, 53, 541-545. https://doi.org/10.1002/uog.20124
[44]
Abdool, Z., Dietz, H.P. and Lindeque, B.G. (2018) Interethnic Variation in Pelvic Floor Morphology in Women with Symptomatic Pelvic Organ Prolapse. International Urogynecology Journal, 29, 745-750. https://doi.org/10.1007/s00192-017-3391-7
[45]
Tezelli Bortolini, M.A. and Rizk, D.E.E. (2011) Genetics of Pelvic Organ Prolapse: Crossing the Bridge between Bench and Bedside in Urogynecologic Research. International Urogynecology Journal, 22, 1211-1219. https://doi.org/10.1007/s00192-011-1502-4
[46]
Ward, R.M., Velez Edwards, D.R., Edwards, T., Giri, A., et al. (2014) Genetic Epidemiology of Pelvic Organ Prolapse: A Systematic Review. American Journal of Obstetrics & Gynecology, 211, 326-335. https://doi.org/10.1016/j.ajog.2014.04.006
[47]
Feiner, B., Fares, F., Azam, N., Auslender, R., David, M. and Abramov, Y. (2009) Does COLIA1 SP1-Binding Site Polymorphism Predispose Women to Pelvic Organ Prolapse? International Urogynecology Journal, 20, 1061-1065. https://doi.org/10.1007/s00192-009-0895-9
[48]
Gabriel, B., Watermann, D., Hancke, K., Gitsch, G., Werner, M., Tempfer, C., et al. (2006) Increased Expression of Matrix Metalloproteinase 2 in Uterosacral Ligaments Is Associated with Pelvic Organ Prolapse. International Urogynecology Journal, 17, 478-482. https://doi.org/10.1007/s00192-005-0045-y
[49]
Huebner, M., Margulies, R.U. and DeLancey, J.O.L. (2008) Pelvic Architectural Distortion Is Associated with Pelvic Organ Prolapse. International Urogynecology Journal, 19, 863-867. https://doi.org/10.1007/s00192-007-0546-y
[50]
Takano, C.C., Girão, M.J.B.C., Sartori, M.G.F., Castro, R.A., Arruda, R.M., Simões, M.J., et al. (2002) Analysis of Collagen in Parametrium and Vaginal Apex of Women with and without Uterine Prolapse. International Urogynecology Journal, 13, 342-345. https://doi.org/10.1007/s001920200076
[51]
De Landsheere, L., Munaut, C., Nusgens, B., Maillard, C., Rubod, C., Nisolle, M., et al. (2013) Histology of the Vaginal Wall in Women with Pelvic Organ Prolapse: A Literature Review. International Urogynecology Journal, 24, 2011-2020. https://doi.org/10.1007/s00192-013-2111-1
[52]
Man, W.C., Ho, J.Y.P., Wen, Y., Sokol, E.R., Polan, M.L. and Chen, B. (2009) Is Lysyl Oxidase-Like Protein-1, α-1 Antitrypsin and Neutrophil Elastase Site Specific in Pelvic Organ Prolapse? International Urogynecology Journal, 20, 1423-1429. https://doi.org/10.1007/s00192-009-0905-y
[53]
Jones, R., et al. (2014) Determinants of Incomplete Penetrance and Variable Expressivity in Heritable Cardiac Arrhythmia Syndromes. Translational Research, 161, 1-14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3624763/pdf/nihms412728.pdf
