Screening for Pelvic Organ Prolapsed without Physical Examination: Validation of the Pelvic Organ Prolapse Simple Screening Inventory (POPSSI)

Abstract

Pelvic organ prolapse occurs with descent of one or more pelvic structures: the uterine cervix or vaginal apex, anterior vagina (usually with bladder, cystocele),posterior vagina (usually with rectum, rectocele), or peritoneum of the cul-de-sac(usually with small intestine, enterocele).However, a specific definition of whatconstitutes clinically significant prolapse remains elusive[1]. POP results from relaxation of the pelvic floor muscle and is estimated to have aprevalence of 30-50% among women aged 50and over[1].Although mortalityresulting from POP is not significant it has a huge impact on the daily activities ofwomen afflicted by this condition, often disruptingand decreasing their quality oflife[2].POP and its complications impose a considerable economic burden on the personand it has been estimated that about 11% of women undergo surgery for POPbefore the age of 79 and with29.2% require repeated surgery[3],[4],[5]. Highparity is the single most important risk factor for prolapse in rich and poorwomen in both more and less developed countries[6]. Many women with pelvic floor disorder do not seek medical advice and thismakes determining its incidence very difficult. In 1996, International Continence Societydefined a system of pelvic organprolapsequantification (POP-Q) demonstrating high inter and intra observerreliability. It allows researchersto report findingsin standardized, easilyreproduciblefashion. Prolapse in each segment is measured relative to thehymen, which is a fixedanatomic landmark that can be identifiedconsistently. Accordingly, it is stage one when the leading prolapsed part ismore than one centimeters above the hymenal ring; stage twowhen it isbetween one centimeter above and one centimeter below thehymenal ring;stage threewhen it is more than one centimeter below thehymenal ringbut less than total vaginal length(TVL) minus two centimeters, and stage fourif itis more than (TVL-2) cm below the hymenal ring[7].In Ethiopia, where accesstoobstetric care is very limited(institutional delivery being only 10 %) and thefertility rateis high(5.5 children per woman) little is known aboutthe prevalenceand risk factors for pelvic floor disorders.