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Study reveals pelvic organ prolapse, incontinence are common for women

IOWA CITY, Iowa -- Approximately one in nine Caucasian women will have surgery for pelvic organ prolapse or urinary incontinence before the age of 80, according to a study led by a University of Iowa College of Medicine researcher.

Pelvic organ prolapse is the loss of muscle strength and connective tissue attachments that support the bladder, uterus, vagina and rectum. When the support is lost, these organs drop, putting pressure on the vagina or descending through the vaginal opening.

"This is the first epidemiologic study to determine the number of women who undergo surgery for pelvic organ prolapse and urinary incontinence. Pelvic organ dysfunction is a major health and quality of life issue," says Dr. Ambre Olsen, UI associate in obstetrics and gynecology. "Gynecologists have known for a long time that these are common problems but no one knew how common they truly are."

According to the study published in the April issue of Obstetrics and Gynecology, 11 percent of women will have surgery to repair pelvic organ prolapse and/or urinary incontinence, but Olsen says the number of women who experience pelvic floor dysfunction is probably much higher.

"A report of surgically-treated patients represents just the tip of the iceberg," she says. "There have not been any studies showing how many women are treated conservatively (without surgery) or the number of women who never have sought treatment."

Researchers studied a general population of 150,000 women over 20 years of age and identified 384 who had undergone surgery for organ prolapse and/or incontinence during 1995. The risk of surgery for prolapse or incontinence increased with advancing age. Approximately 30 percent of the operations were repeated for recurring dysfunction problems. Possible reasons for such a high incidence of multiple surgeries may include an underlying connective tissue disease or nerve damage which are not repairable with surgery to the connective tissue. Not finding all of the support defects before the initial operation may be another factor.

While her study focused on surgical repair, Olsen stresses that an operation is not the best treatment choice for every woman. Conservative therapies, such as pelvic floor exercises or the use of a vaginal support device, may be better treatments for certain patients.

Olsen hopes to debunk the myth that these conditions are a normal consequence of aging and that little can be done to help women with these problems.

"This proves that prolapse and incontinence are common conditions. The next steps are to get a sense of the prevalence of women not treated surgically, identify risk factors and clearly define treatment outcomes," Olsen says.

4/3/97