title: Vaginal wall descensus and pelvic floor symptoms in older women.
abstract: OBJECTIVE
  To understand the clinical significance of early pelvic organ prolapse in older women, we studied associations between vaginal descensus and pelvic floor symptoms.
  
  
  METHODS
  In this cross-sectional study, 270 women enrolled at one site of the Women's Health Initiative clinical trial completed a questionnaire modified from the Pelvic Floor Distress Inventory on pelvic floor symptoms and underwent a Pelvic Organ Prolapse Quantification (POP-Q) examination. We tested associations between symptoms (individual and grouped) with anterior, posterior, uterine, and maximum vaginal descensus.
  
  
  RESULTS
  Mean age was 68 years. Ninety-six percent had POP-Q stages I or II. Only obstructive urinary symptoms and feeling a bulge were associated with vaginal descensus. Obstructive urinary symptom scores increased as anterior (P = .04), posterior (P < .01), and maximal (P = .01) vaginal descensus increased. Urinary incontinence or bowel symptoms were not associated with descensus of any vaginal compartment. ''See or feel a bulge,'' reported by 11 women (4%), was associated with descensus in all compartments (P < or = .04 for all) and with prolapse at or beyond the hymen (P < .001). This symptom was specific (100%), but not sensitive (16%) for prolapse, defined as descensus at or beyond the hymen.
  
  
  CONCLUSIONS
  Vaginal support defects in older women are associated with obstructive urinary symptoms and the symptom of seeing or feeling a bulge. However, symptoms are not useful in discriminating between women with and without milder vaginal wall descensus. Based on these results, we suggest that other etiologies for bothersome bladder or bowel complaints be considered before performing surgery for early pelvic organ prolapse.
authors.affiliation: Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242, USA. catherine-bradley@uiowa.edu
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Bradley
authors.forename: Ingrid E
authors.initials: IE
authors.lastname: Nygaard
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000209:etiology*; D003430:Cross-Sectional Studies; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor; D017699:Pelvic Pain / Q000209:etiology*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014549:Urinary Incontinence / Q000209:etiology*; D014596:Uterine Prolapse / Q000150:complications* / Q000473:pathology