PELVIC ORGAN PROLAPSE QUANTIFICATION PROFILE OF WOMEN IN ILE-IFE, NIGERIA: DETERMINANTS AND SYMPTOM CORRELATION
INTRODUCTION: Pelvic organ prolapse (POP) when symptomatic, could be highly
distressing, particularly with increasing severity of prolapse. Unfortunately, the condition is undiagnosed and unreported by affected women, resulting in long term sufferings. Its true incidence using validated method of examination in a wider range of population of women needs evaluation in our environment, and identification of determinants will facilitate preventative measures and early diagnosis.
AIM: To determine the prevalence of the different Pelvic Organ Prolapse Quantification(POPQ) stages of pelvic organ prolapse, correlate these stages with clinical symptoms and identifying the determinants of pelvic organ prolapse among women in Ile-Ife, Nigeria.
METHODS: This was a cross sectional study of consecutive, consenting four hundred women (aged 22-74years) attending the Gynaecology, General Outpatient, Family Planning, and Well-Woman clinics at Obafemi Awolowo University Teaching Hospitals Complex, Ile- Ife, Nigeria. The subjects’ relevant biodata and selected determinants ofPOPQ were documented in a purpose designed and pre-tested questionnaire, and the International Consultation on Incontinence Questionnaire Vaginal Symptoms (ICIQ-VS) was administered. Thereafter, the POPQ examination was performed in semi-recumbent position, using the IUGA stix for measurement. The obtained data were analysed using IBM SPSS version 20.0. The prevalence of the different POPQ stages was determined and expressed as proportions. Receiver Operating Characteristic (ROC) analysis was performed to determine the sensitivity, specificity and ideal cut-off score of ICIQ-VS for
predicting POPQ stages. Logistic regression analysis was then performed to identify the significant determinants in this population.
RESULTS: The mean age of the participants was 39.9 ± 10.5 years with a mean parity of 2.95 ± 1.68. The study showed a prevalence of pelvic organ prolapse quantification of 13% (stage 0), 85.3% (stage I), 1.3% (stage II) and `0.5% (stage III). None of the participants had stage IV prolapse. There was significant association between pelvic organ prolapse and the feeling of lump in the vagina. Age, parity, menopausal status, chronic constipation, childbirth position, caesarean section and lifting of heavy objects were the identified significant determinants.
CONCLUSION: Stage I prolapse is the most prevalent of the POPQ stages in this study population. There is a significant correlation between POPQ stage and the symptom‘feeling of lump in the vagina’.
RECOMMENDATIONS: A multi-centre study is recommended to further popularise the use of POPQ examination in the assessment of pelvic organ prolapse and can be extended into use in our daily clinic activities. Chronic constipation and lifting of heavy objects are modifiable significant risk factors which should be avoided to reduce susceptibility to pelvic organ prolapse. Genetic study of this population is recommended in order to determine how much protection it confers against development of pelvic organ prolapse. Case control study is advocated to further define the epidemiology of pelvic organ prolapse.