Pelvic Organ Prolapse and Seeking Urogynecological Support

Yıl 2020, Cilt: 42 Sayı: 5, 532 - 540, 15.09.2020

Adnan Orhan , Kiper Aslan

https://doi.org/10.20515/otd.622839

Cited By: 2

Öz

Pelvic organ prolapse is the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus, or the vaginal vault. Many patients with pelvic organ prolapse do not actually come to the doctor or seek medical support too late, although it may impair quality of life. This study aimed to determine the period when the patients with pelvic organ prolapse applied to the doctor, the time between the onset of symptoms and the time of admission to the doctor, and the cause of seeking medical advice. In this prospective study, Pelvic Organ Prolapse Quantification System (POP-Q) classification of the patients who came to our urogynecology outpatient clinic with the complaint of vaginal bulging was performed and the time between the prolapse symptoms and the moment when the patient was admitted to the clinic was investigated. 1473 patients admitted to our urogynecology outpatient clinic with pelvic organ prolapse between 01.01.2018 - 31.05.2019. Although 11.4% of the patients applied to the doctor as soon as they had become symptomatic, 42.7% applied to the doctor after 1-3 years. Even though anterior or apical compartment prolapse was frequently seen at admission, the probability of developing complete uterine prolapse increased significantly as the time of admission to the doctor was prolonged. The main reason for seeking medical support in prolapse patients was the deterioration in the quality of life. Although pelvic floor defects are common in women with advancing age, only about 10% of the patients go to a doctor as soon as they are symptomatic. All the remaining patients delayed admission to the doctor for various reasons and attempted to solve this problem on their own. There is a need to raise awareness of pelvic organ prolapse and the pelvic floor in the whole population.

Anahtar Kelimeler

Pelvic organ prolapse, Seeking medical support, Quality of life

Pelvik Organ Prolapsusunda Semptomlar ile Kliniğe Başvuru Süreleri Arasındaki İlişki

Öz

Pelvik organ prolapsusu kadın hayatının ilerleyen yaşlarında çok sıklıkla görülen parite, ilerleyen yaş ve obezitenin temel risk faktörleri olduğu bir anatomik rahatsızlıktır. Her ne kadar yaşam kalitesini bozsa da birçok pelvik organ prolapsuslu hasta aslında doktora gelmemekte veya çok geç doktora başvurmaktadır. Bu çalışmanın amacı pelvik organ prolapsuslu hastaların hangi aşamada doktora başvurduğu, semptomların başlangıcı ile doktora başvuru arasında ne kadar sürenin geçtiğini ve asıl hangi nedenin doktora başvuru sebebi olduğunu saptamaktır. Bu prospektif araştırmada pelvik organ prolapsusu şikâyeti ile ürojinekoloji polikliniğimize gelen hastaların Pelvic Organ Prolapse Quantification System (POP-Q) pelvik muayenesi yapılarak, hastaların ana başvuru nedeni ve hastaların semptomatik olduğu andan itibaren doktora gelene kadar geçen süre araştırılmıştır. Çalışma kapsamında 1473 hasta ürojinekoloji polikliniğimize 01.01.2018 – 31.05.2019 tarihleri arasında pelvik organ prolapsusu nedeni ile başvurmuştur. Hastaların %11,4’ü semptomatik olur olmaz doktora başvurduğu halde, %42,7’si 1-3 yıl sonra doktora başvurmuştur. Başvuru esnasında sıklıkla anterior veya apikal kompartman prolapsusu görülmesine rağmen, doktora başvuru süresi uzadıkça komplet uterin prolapsus gelişme ihtimali belirgin derecede artıyordu. Pelvik organ prolapsusu nedeni ile tarafımıza başvuran hastaların ana başvuru sebebi yaşam kalitesinde bozulmaydı. Pelvik taban defektleri kadınlarda ilerleyen yaşla birlikte çok sık görülmesine rağmen hastaların sadece %10 kadarı semptomatik olduğu anda doktora başvurmaktadır. Geriye kalan tüm hastalar çeşitli nedenlerle doktora başvuru geciktirmekte ve bu sorunu kendi başlarına çözmeye kalkışmaktadırlar. Tüm toplumda pelvik organ prolapsusu ve pelvik taban ile ilgili olarak daha fazla farkındalık oluşturmaya gerek vardır. 

Anahtar Kelimeler

Pelvik organ prolapsusu, Kliniğe başvuru süresi, Yaşam kalitesinde bozulma

Kaynakça

• 1. Nygaard I, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6.
• 2. Slieker-ten Hove MC, et al. The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population. Int Urogynecol J Pelvic Floor Dysfunct. 2009; 20(9):1037–45.
• 3. Tegerstedt G, et al. Prevalence of symptomatic pelvic organ prolapse in a Swedish population. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(6):497–503.
• 4. Whitcomb EL, et al. Racial differences in pelvic organ prolapse. Obstet Gynecol. 2009;114(6):1271–7.
• 5. Elbiss HM, Osman N, Hammad FT. Prevalence, risk factors and severity of symptoms of pelvic organ prolapse among Emirati women. BMC Urol. 2015;15:66.
• 6. McLennan MT, et al. Family history as a risk factor for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(8):1063–9.
• 7. Bradley CS, Nygaard IE. Vaginal wall descensus and pelvic floor symptoms in older women. Obstet Gynecol. 2005;106(4):759–66.
• 8. Hendrix SL, et al. Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186(6):1160–6.
• 9. Mouritsen L, Larsen JP. Symptoms, bother and POPQ in women referred with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2003; 14(2):122–7.
• 10. Oliphant SS, Jones KA, Wang L, et al. Trends over time with commonly performed obstetric and gynecologic inpatient procedures. Obstet Gynecol 2010; 116:926.
• 11. Wu JM, Hundley AF, Fulton RG, Myers ER. Forecasting the prevalence of pelvic floor disorders in U.S. Women: 2010 to 2050. Obstet Gynecol 2009; 114:1278.
• 12. Sung VW, Washington B, Raker CA. Costs of ambulatory care related to female pelvic floor disorders in the United States. Am J Obstet Gynecol 2010; 202:483.e1.
• 13. Lowder JL, Ghetti C, Nikolajski C, et al. Body image perceptions in women with pelvic organ prolapse: a qualitative study. Am J Obstet Gynecol 2011; 204:441.e1.
• 14. Pakbaz M, et al. Vaginal prolapse–perceptions and healthcare-seeking behavior among women prior to gynecological surgery. Acta Obstet Gynecol Scand. 2011;90(10):1115–20.
• 15. Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.
• 16. https://www.iuga.org
• 17. Rortveit G, et al. Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort. Obstet Gynecol. 2007; 109(6):1396–403.
• 18. Brazell HD, O'Sullivan DM, Tulikangas PK. Socioeconomic status and race as predictors of treatment-seeking behavior for pelvic organ prolapse. Am J Obstet Gynecol. 2013;209(5):476.e1–5.
• 19. Pakbaz M, et al. A hidden disorder until the pieces fall into place’–a qualitative study of vaginal prolapse. BMC Womens Health. 2010;10:18.
• 20. Kinchen KS, et al. Factors associated with women's decisions to seek treatment for urinary incontinence. J Women's Health (Larchmt). 2003;12(7): 687–98.
• 21. Morrill M, et al. Seeking healthcare for pelvic floor disorders: a population based study. Am J Obstet Gynecol. 2007;197(1):86. e1–6
• 22. Hammad FT, Elbiss HM, Osman N. The degree of bother and healthcare seeking behaviour in women with symptoms of pelvic organ prolapse from a developing gulf country. BMC Womens Health. 2018 May 30;18(1):77.
• 23. Hatchett L, et al. Knowledge and perceptions of pelvic floor disorders among african american and Latina women. Female Pelvic Med Reconstr Surg. 2011;17(4):190–4
• 24. Koch LH. Help-seeking behaviors of women with urinary incontinence: an integrative literature review. J Midwifery Womens Health. 2006;51(6):e39–44.
• 25. Lewicky-Gaupp C, Margulies RU, Larson K, Fenner DE, Morgan DM, DeLancey JO. Self-perceived natural history of pelvic organ prolapse described by women presenting for treatment. Int Urogynecol J Pelvic Floor Dysfunct. 2009 Aug;20(8):927-31.