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Is Pelvic Organ Prolapse All in the Family?

Concordance among sisters suggests a strong familial predisposition.

Vaginal delivery, increased BMI, age, and vaginal hysterectomy are risk factors for pelvic organ prolapse. This condition is more common in Caucasians than in African Americans or Asians, suggesting that genetic factors may also be involved. To determine the relative roles of vaginal delivery and familial factors in the development of prolapse, investigators compared 101 pairs of nulliparous and parous (>1 vaginal delivery) postmenopausal sisters.

The women completed questionnaires regarding urinary incontinence and prolapse and underwent clinical examination. Prolapse was quantified using the Pelvic Organ Prolapse Quantification staging system. Of the 101 pairs, 82% of nulliparous and 44% of parous women had no pelvic organ prolapse. When prolapse was observed, there was very high concordance among sister pairs in prolapse stage by compartment (concordance rate, 74.3% anterior, 75.3% posterior, and 91.1% apical). Among most of the discordant sister pairs, the parous sister had a more advanced stage of prolapse than the nulliparous sister. Few correlations other than having an affected sibling were observed. BMI, age, and diabetes were not associated with prolapse.

Comment: These findings support a heritable component for female incontinence. Elective cesarean delivery might not spare patients from future prolapse or incontinence, especially when there is a positive family history.

— Sandra Ann Carson, MD

Published in Journal Watch Women's Health February 15, 2007

Citation(s):

Buchsbaum GM et al. Pelvic organ prolapse in nulliparous women and their parous sisters. Obstet Gynecol 2006 Dec; 108:1388-93.

• Medline abstract (Free)