Prevalence and risk factors of pelvic organ prolapse among women in Sidama region, Ethiopia: A community-based survey

Womens Health (Lond). 2024 Jan-Dec:20:17455057241265078. doi: 10.1177/17455057241265078.

Abstract

Background: Pelvic organ prolapse is a descent of the vaginal compartments and the surrounding organ due to loss of support of the vaginal tissue. It has a significant psychological, physical, and social impact that affects women's quality of life. However, its true prevalence is unknown due to the variability in the methods used to diagnose the disorder.

Objectives: This study aimed to determine the prevalence of pelvic organ prolapse and its associated risk factors among women in Sidama region, Ethiopia.

Study design: A community-based cross-sectional survey was conducted in the Dale-Wonsho Health and Demographic Surveillance Site, Sidama region, from March to October 2023.

Methods: A multi-stage stratified cluster sampling was used to select a sample of 816 women. Anatomical prolapse was diagnosed based on the standardized pelvic organ prolapse quantification method, and symptomatic prolapse was assessed by patient-reported symptoms. A complex survey-based modified Poisson regression was used to assess the risk factors associated with prolapse.

Results: A total of 815 participated in the interview, and 779 (95.6%) underwent pelvic examination to assess for prolapse status. Anatomical prolapse (Stages II-IV) was observed in 241 (30.9%; 95% confidence interval = 24-38.7) of the participants. The prevalence of symptomatic pelvic organ prolapse was 78.5% (95% confidence interval = 69.1-85.7) among women with anatomical prolapse (189/241). This prevalence falls to 24.27% (95% confidence interval = 19.98-29.16) for the total sample population. Higher frequency of childbirth, prolonged heavy lifting activities, and prolonged labor increased the likelihood of developing anatomical prolapse. Childbirth at an early age and prolonged heavy lifting activities were significantly associated with symptomatic prolapse.

Conclusion: Anatomical prolapse and symptomatic prolapse are high in the study area. Parity, prolonged heavy lifting, prolonged labor, and early age childbirth were associated with pelvic organ prolapse. Community-based education and interventions that focus on the modification of risk factors are needed.

Keywords: Ethiopia; POP-Q; anatomical prolapse; pelvic organ prolapse; prolapse symptoms.

Plain language summary

A study on pelvic organ prolapse confirmed through physical examination and symptoms of prolapse assessed among women in Sidama region of EthiopiaWhy was the study done? Pelvic organ prolapse occurs when one or more vaginal compartments and their surrounding organs drop from their normal position. Imagine the pelvic floor as a supportive sling made of muscles, ligaments, and tissues. These structures usually hold organs, such as vagina, bladder, uterus, and rectum in place. However, when the pelvic floor weakens due to factors, such as pregnancy, childbirth, or menopause, these organs bulge. Symptoms may include feeling a tissue bulge near the vaginal opening, pelvic pressure, lower back pain, urinary changes, and even difficulty keeping in a tampon. However, evidence about how common the problem is in the Sidama region is limited. This may hinder the need for efforts to be taken in identifying and treating the disorder. What did the researchers do? The research team assessed the symptoms of prolapse by asking women through house-to-house visits invited them to the nearby health facility and conducted pelvic examination to confirm the presence of prolapse. Women’s characteristics that can be related to prolapse were also assessed through interview. What did the researchers find? A total of 815 women participated in interviews on prolapse symptoms, and 779 underwent pelvic examination. Among those examined, one in three women (241/779) has a physically confirmed prolapse. Among the confirmed prolapses, 189 women reported symptom of prolapse. Women who have birth many times, who work on prolonged heavy lifting activities, and who have a history of labor that lasted more than 24 h have a high chance to develop prolapse. Similarly, those who gave birth before the age of 18 years and those engaged in prolonged heavy lifting activities have higher chance of developing prolapse symptoms. What do the findings mean? The findings showed that prolapse is common in the Sidama region of Ethiopia and that it needs attention of stakeholders.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cross-Sectional Studies
  • Ethiopia / epidemiology
  • Female
  • Humans
  • Middle Aged
  • Pelvic Organ Prolapse* / epidemiology
  • Prevalence
  • Quality of Life
  • Risk Factors
  • Surveys and Questionnaires
  • Young Adult