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Obstetrics & Gynecology 2008;112:851-858
© 2008 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Symptoms and Pelvic Support Defects in Specific Compartments

Ann Miedel, MD1, Gunilla Tegerstedt, MD, PhD1, Marianne Maehle-Schmidt, PhL2, Olof Nyrén, MD, PhD3 and Margareta Hammarström, MD, PhD1

From the 1Department of Obstetrics and Gynaecology and Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; 2Statisticon AB Uppsala, Sweden; and the 3Department of Medical Epidemiology and Biostatistics Karolinska, Institutet, Stockholm, Sweden.

OBJECTIVE: To investigate whether the nature of the anatomic defects in pelvic organ prolapse (POP) correlates with the character of the symptoms.

METHODS: This study was a cross-sectional investigation within a population-based sample. Two hundred eighty women who had completed a symptom questionnaire were examined according to POP quantification by two gynecologists blinded to symptom reports.

RESULTS: An age- and parity-adjusted logistic regression model, controlling for POP in other compartments, revealed that the feeling of vaginal bulge was specific to prolapse but not to any particular compartment, although the association was strongest with anterior-wall prolapse (odds ratio [OR] for the symptom among women with stage II–IV relative to stage 0 was 5.8, 95% confidence interval [CI] 2.5–13.3). Urge urinary incontinence tended to be linked to POP in either the anterior or posterior wall, but the association was stronger with anterior-wall prolapse. Stress urinary incontinence was strongly linked to posterior-wall prolapse (stage II–IV OR 5.4, 95% CI 1.9–15.2). Self-reports of hard/lumpy stool and difficult or painful defecation tended to be associated with anterior-wall prolapse but without consistent relationships with stage. Painful defecation was the only bowel symptom significantly linked to posterior-wall prolapse (P=.05).

CONCLUSION: Pelvic floor–related symptoms do not predict the anatomic location of the prolapse in women with mild to moderate prolapse.

LEVEL OF EVIDENCE: II






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