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Abdominal pressure and pelvic organ prolapse: is there an association?

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Abstract

Introduction and hypothesis

The primary aim of this study was to assess for an association between maximal intra-abdominal pressure reached on Valsalva (MAP) and pelvic organ prolapse (POP) on subjective, clinical and sonographic evaluation. Another objective was to test for association between MAP and body mass index (BMI).

Methods

A retrospective cross-sectional study was carried out on 504 archived datasets of women seen for pelvic floor dysfunction symptoms between January 2017 to September 2019 at a tertiary urogynaecology clinic. Patients underwent a standardized interview including use of visual analogue scores (VAS) to evaluate bother of pelvic floor symptoms, examination using the International Continence Society Pelvic Organ Prolapse Quantification (ICS POP-Q), dual-channel filling and voiding cystometry, test for MAP as well as four-dimensional (4D) transperineal ultrasound. Analysis of ultrasound volumes for pelvic organ descent was performed blinded against all other data.

Results

There was a weak but significant association between MAP and sonographic rectal ampulla descent (p = 0.0275). There was also a significant association between MAP and bother of obstructed defecation symptoms (p = 0.0065). Symptomatic, clinical and sonographic POP in the anterior or the apical compartments was not significantly associated with MAP. On multivariate analysis, the association between MAP and rectal descent remained significant (p = 0.01). There was no significant association between BMI and MAP.

Conclusions

This cross-sectional study showed an association between MAP and posterior compartment prolapse on imaging as well as between MAP and the bother score of obstructed defecation symptoms. There was no association between BMI and MAP.

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Authors and Affiliations

  1. Robina Hospital, 2 Bayberry Lane, Robina, QLD, Australia

    Yu Hwee Tan

  2. Department of Urogynaecology, Varsity Lakes Day Hospital, 2 Lake Street, Varsity Lakes, QLD, 4227, Australia

    Yu Hwee Tan

  3. Kaplan Medical Center, Rehovot, Israel

    Moshe Gillor

  4. University of Sydney, Penrith, NSW, Australia

    Moshe Gillor & Hans Peter Dietz

Authors
  1. Yu Hwee Tan
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  2. Moshe Gillor
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  3. Hans Peter Dietz
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Contributions

YH Tan: Protocol/project development; Data collection, management and analysis; Manuscript writing.

M Gillor: Data analysis; Manuscript editing.

HP Dietz: Protocol/project development; Manuscript editing.

Corresponding author

Correspondence to Yu Hwee Tan.

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Conflict of interest

HP Dietz received lecture honoraria and travel assistance from GE Medical and Mindray. YH Tan and M Gillor declare they have no conflict of interest.

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Oral abstract presentation at Urogynaecological Society of Australasia ASM 2020 (Virtual), 20– 21 November 2020

E-Poster presentation at IUGA 45th Annual Scientific Meeting 2020 (Virtual); 29 August–4 September 2020.

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Tan, Y.H., Gillor, M. & Dietz, H.P. Abdominal pressure and pelvic organ prolapse: is there an association?. Int Urogynecol J 33, 337–342 (2022). https://doi.org/10.1007/s00192-021-04811-0

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  • DOI: https://doi.org/10.1007/s00192-021-04811-0

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