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Vaginal Descent and Pelvic Floor Symptoms in Postmenopausal Women

A Longitudinal Study

From the ¹Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa; ²Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa; and ³Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah.

OBJECTIVE: To determine whether vaginal descent changes are associated with pelvic floor symptoms in postmenopausal women.

METHODS: This 4-year prospective study included 260 postmenopausal women with an intact uterus enrolled at one Women's Health Initiative (WHI) clinical trial site. All completed at least two annual pelvic organ prolapse quantification (POP-Q) examinations and symptom questionnaires (30 bladder, bowel, and prolapse symptom items, modified from the Pelvic Floor Distress Inventory). Symptoms were grouped, and group scores categorized into two or three evenly distributed levels. Year 4 data collection was incomplete because the overall WHI study halted. Generalized logistic linear models and generalized estimating equation methods were used to measure associations between vaginal descent and a symptom or symptom score, controlling for time, age, and body mass index (BMI).

RESULTS: Mean age was 68±5 years, BMI 30±6 kg/m², and median parity 4. Ninety-five percent of women had POP-Q stages I–II prolapse. Increasing maximal vaginal descent was associated with "see/feel a bulge" and "sensation of protrusion or bulging," and with obstructive bladder, prolapse, and obstructive bowel scores. Increasing apical descent (POP-Q point C) was associated with "see/feel a bulge," increasing anterior descent (POP-Q point Ba) with bladder pain and obstructive bladder scores, and increasing posterior descent (POP-Q point Bp) with the bowel incontinence score.

CONCLUSION: Although previous work showed that most pelvic floor symptoms correlated poorly with levels of early prolapse, longitudinal analysis suggests that vaginal descent progression over time is positively associated with various bladder, bowel, and prolapse symptoms in postmenopausal women with stages I–II prolapse.

LEVEL OF EVIDENCE: II