Age-related Pelvic Floor Modifications and Prolapse Risk Factors in Postmenopausal Women

Andrea Tinelli, MD; Antonio Malvasi, MD; Siavash Rahimi, MD; Roberto Negro, MD; Daniele Vergara, MD, PhD; Roberta Martignago, PhD; Marcello Pellegrino, MD; Carlo Cavallotti, Prof, MD, PhD

Disclosures

Menopause. 2010;17(1):204-212. 

In This Article

Abstract and Introduction

Abstract

Objective: Genital prolapse is frequent in postmenopausal women; it describes the loss of support to the pelvic organs, resulting in a herniation of these into the vaginal channel. This problem affects 50% of parous women, and at least 50% of all women develop a mild form of genital prolapse after pregnancy.
Methods: An extensive literature review from 1990 to 2008 was performed on prolapse etiology and its risk factors; analyzing the data, we reviewed the genetic and biological aspects, age-related prolapse, biological tissue modifications, surgical problems, pelvic musculature modifications, and neuropathy.
Results: Data suggested that aging, pelvic trauma, and surgery evoke tissue denervation and devascularization, anatomic alterations, and increased degradation of collagen; all of these may lead to a decrease in mechanical strength and predispose an individual to prolapse. It has been demonstrated that there is a reduction in protein content and estrogens in uterosacral ligaments, in the vagina, and in the parametrium of women with prolapse. This is a possible explanation for why many surgical procedures to correct prolapse fail and recurrences after surgical correction are frequent.
Conclusions: Even if the etiology of pelvic prolapse is poorly defined and multifactorial, aging risk factors, such as biomechanical abnormalities in connective tissue composition, hormonal deficiency, and irregular tissue metabolism, are nonmodifiable and therefore largely stated in clinical practice. Regardless of future developments, based on the reported findings, prolapse therapy will be more influenced by genetics, biological pelvic changes, changes in tissue homeostasis, and topical hormones, rather than general pelvic corrective surgical anatomy.

Introduction

Female pelvic organ prolapse (POP), or genital or genitourinary prolapse, is a common condition; it refers to a loss of fibromuscular support of the pelvic viscera resulting in a vaginal protrusion and describes the descent of the pelvic organs into the vaginal canal. The pelvic organs are supported by both the muscles of the pelvic floor and their intact attachments to the endopelvic fascia: damage to this compartment leads to POP.[1]

Moreover, prolapse is another word for hernia of the muscles that lies under the pelvic organs; it conveys a significant burden on individuals and society, even if it rarely threatens the general health and/or life of the person. Genitourinary prolapse is a common complaint, with approximately 11% of all women requiring at least one corrective surgical procedure.[2]

The etiology of female POP is equally poorly defined and maybe multifactorial. Although several articles were published to clarify the risk factors related to prolapse, the aim of this review is to provide information about the mechanisms involved in female pelvic prolapse and directions for possible target therapy.

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