The study conducted to create a baseline guide, where volunteers have been assessed for pelvic organ prolapse progression on an annual basis, who had at least one child within the last five to ten years.
A team of Baltimore physicians reported a long-awaited baseline of a rate of progression of pelvic organ prolapse by measuring the sagging of the vaginal walls in more than a thousand volunteers for up to nine years annually. The baseline should provide a piece of information for reliable studies and to prevent or ease the condition.
Victoria Handa, M.D. et al. said, “The good news is that pelvic organ prolapse progresses slowly." That means there is a lot of time to intervene before noticeable discomfort occurs, but more research is needed to allow doctors to accurately predict which women will develop severe prolapse and which will require surgical therapy.
In 1996, an international group of experts agreed on a simple system to approximate the extent of prolapse. The distance between vaginal opening to the front of the vagina (near the bladder), to the back wall of the vagina (near the rectum) and the top of the vagina (near the uterus) was measured. The shorter the distances are, there is less vaginal support.
"Unfortunately, not all gynecologists are trained to perform these measurements, and they aren't part of routine checkups because we don't know how to use the information to benefit the patient yet," added Handa.
To create a baseline guide, Handa used those three measurements to assess prolapse progression on an annual basis in 1,224 volunteers seen in Baltimore clinics who had at least one child within the last five to 10 years. The women were followed for two to nine years.
While about 20 percent of the women studied had no change in support or improved support, all other participants experienced a gradual failing. The most rapid decline was seen in the front vaginal wall support, which sagged at a rate of 0.5 centimeters every five years, on average.
"Women who are told they have mild prolapse shouldn't start worrying or jump to the conclusion that they will need surgery. Vaginal support won't get worse quickly, and it could even improve on its own" said Handa.
The study also revealed that women who gave birth vaginally were about five more years ahead in the progression of prolapse than those who delivered by Caesarean section. Handa warns that this should not be used to encourage C-sections, but it is helpful in trying to understand the risk factors for prolapse better.
Finally, the researchers found that the genital hiatus, which can also be measured at the time of vaginal examination. The genital hiatus is an exterior measurement from the opening of the urethra to the base of the vaginal opening. It is wider in women who have had a vaginal birth, the study found.
The widening is independently associated with declining support inside the vagina and a faster rate of prolapse progression. It is a clue that whatever is affecting the size of the genital hiatus also seems to be affecting prolapse progression.