Prevalence & Statistics
In a recent population-based analysis, Wu et al found that the lifetime risk of surgery for either stress incontinence or pelvic organ prolapse was 20.0%. Thus, in a hypothetical cohort of women, currently 18 years of age, one out of every five would be expected to undergo surgery for either stress incontinence or pelvic organ prolapse before they reach 80, highlighting the public health effect of these conditions. For perspective, a woman’s lifetime risk of developing breast cancer is 14.8%.
The exact prevalence of POP is certainly higher but difficult to ascertain for several reasons:
- Different classification systems have been used for diagnosis;
- Studies vary by whether the rate of prolapse reported is for women who are symptomatic or asymptomatic; and
- It is unknown how many women with POP do not seek medical attention (22).
Why is POP so Prevalent?
Given the lack of accuracy, most of gynecologist won’t bother to even document the level of prolapse and there is no way to monitor the progress of the prolapse over the years. Introduction of the Pelvic Organ Prolapse Quantification (POP-Q) system in 1996 was a very critical step in creating a standard method accurate measurement of the POP. It is important to emphasize that POP-Q system is not a specific device for the measurement of the POP, and it is solely a standardized technique to perform and document a simple pelvic exam. The problem is that accurate POP-Q examinations in the gynecologist’s office are time consuming, cumbersome, and overall has been avoided by most clinicians in women’s health care. Even in the highly trained urogynecologic practice, the POP-Q is not practical and only 40.2% of AUGS and International Continence Society members routinely use the POP-Q system in clinical practice. POP-Q exam is almost not in practice for any general OBGYN physician, given its complexity to perform.
Today, in clinical practice, the measurement of the POP is limited to a visual pelvic exam in the office, and there is no medical device as a standard of care for the diagnosis, and quantification of pelvic organ prolapse. Currently doctors aren’t screening for prolapse unless a patient is symptomatic primarily due to the lack of effective diagnostic tools. If patient is asymptomatic and her gynecologist diagnoses early stage prolapse during the examination, most likely scenario is that:
- Patient won’t be informed of her prolapse
- The degree and type of prolapse won’t be documented.
- No preventative or education will be taken to reduce the risk of the progression of the prolapse in the future.