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      Pelvic Organ Prolapse in Jimma University Specialized Hospital, Southwest Ethiopia

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          Abstract

          Background

          Pelvic organ prolapse is the down ward descent of female organs including the bladder, small and large bowel resulting in protrusion of the vagina, uterus or both. It is a disorder exclusive to women and one of the most common indications for gynecologic surgery.

          Methods

          This hospital based retrospective descriptive study was conducted to assess the magnitude of pelvic organ prolapse and risk factors for it. All cases of pelvic organ prolapse admitted and treated in Jimma University Specialized Hospital from July 1, 2008 to June 30, 2011 were included. The collected data were analyzed using SPSS computer software version 16.0. Chi-square test was used and was considered to be significant when p<0.05.

          Results

          Pelvic organ prolapse accounted for 40.7% of major gynecologic operations. Mean age of patients was 42.43 ± 10.4 years and there was a significant association between prolapse and age of patients (p <0.05). Mean parity of patients was 6.5± 2.64 with a significant association between prolapse and parity (p < 0.05). Majority of them (80.6%) lived in rural area and there was a significant association between prolapse and residence area. Farmers accounted for 68.2% of the patients and there was a significant association between prolapse and occupation (p < 0.05). Risk factors identified were chronic cough (20.9%), constipation (30.2%) with some having more than one risk factor while none was identified in 59.7%.

          Conclusion

          Prolapse is common among rural, farmer, parous and older women where most of them delivered at home with prolonged labor. Age, parity and occupation were associated with the stage of prolapse. Awareness creation on risk factors of pelvic organ prolapse and use of contraception to reduce parity is recommended. Health institution delivery should be advocated to minimize the rate of home deliveries and hence of prolonged labor.

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          Most cited references12

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          Pelvic organ prolapse.

          Pelvic organ prolapse is downward descent of female pelvic organs, including the bladder, uterus or post-hysterectomy vaginal cuff, and the small or large bowel, resulting in protrusion of the vagina, uterus, or both. Prolapse development is multifactorial, with vaginal child birth, advancing age, and increasing body-mass index as the most consistent risk factors. Vaginal delivery, hysterectomy, chronic straining, normal ageing, and abnormalities of connective tissue or connective-tissue repair predispose some women to disruption, stretching, or dysfunction of the levator ani complex, connective-tissue attachments of the vagina, or both, resulting in prolapse. Patients generally present with several complaints, including bladder, bowel, and pelvic symptoms; however, with the exception of vaginal bulging, none is specific to prolapse. Women with symptoms suggestive of prolapse should undergo a pelvic examination and medical history check. Radiographic assessment is usually unnecessary. Many women with pelvic organ prolapse are asymptomatic and do not need treatment. When prolapse is symptomatic, options include observation, pessary use, and surgery. Surgical strategies for prolapse can be categorised broadly by reconstructive and obliterative techniques. Reconstructive procedures can be done by either an abdominal or vaginal approach. Although no effective prevention strategy for prolapse has been identified, considerations include weight loss, reduction of heavy lifting, treatment of constipation, modification or reduction of obstetric risk factors, and pelvic-floor physical therapy.
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            Epidemiology of genital prolapse: observations from the Oxford Family Planning Association Study.

            To explore the epidemiology of uterovaginal and post-hysterectomy prolapse. Cohort study. Seventeen large family planning clinics in England and Scotland. 17,032 women who attended family planning clinics between 1968 and 1974, aged between 25 and 39 years at study entry. Annual follow up by interview, postal or telephone questionnaire until July 1994. Further details on all hospital admissions were obtained from the hospital discharge summaries. All women were flagged at time of recruitment in the NHS central registers. In-patient admission with diagnosis of prolapse (ICD codes 8th Revision 623.0-623-9). The incidence of hospital admission with prolapse is 2.04 per 1000 person-years of risk. Age, parity, calendar period and weight were significantly associated with risk of an inpatient admission with prolapse after adjustment for principal confounding factors. Significant trends were observed with regard to smoking status and obesity (Quetelet Index) at entry to the study and risk of prolapse. Social class, oral contraceptive use and height were not significantly associated with risk of prolapse. The incidence of prolapse which required surgical correction following hysterectomy was 3.6 per 1000 person-years of risk. The cumulative risk rises from 1% three years after a hysterectomy to 5% 15 years after hysterectomy. The risk of prolapse following hysterectomy is 5.5 times higher (95% CI 3.1-9.7) in women whose initial hysterectomy was for genital prolapse as opposed to other reasons. Among the potential risk factors that were investigated, parity shows much the strongest relation to prolapse.
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              Pelvic symptoms in women with pelvic organ prolapse.

              To assess symptoms of bladder, bowel, and sexual function in women with pelvic organ prolapse and to compare symptoms by different degrees of prolapse. This retrospective study used data from 352 women with prolapse or urinary incontinence. The pelvic organ prolapse quantification measurements, as well as responses to 3 self-administered questionnaires assessing urinary, bowel, and sexual function were used. For each individual, pelvic organ prolapse quantification measures of prolapse were obtained in centimeters in relation to the hymen for 3 compartments: anterior vagina, vaginal apex or cervix, and posterior vagina. Data were analyzed by comparing the frequency of symptoms to centimeter measures of the most advanced prolapse (regardless of site) and the other compartments of prolapse. Of the 330 patients available for analysis, 2.4% had stage I, 46.1% had stage II, 48.2% had stage III, and 3.3% had stage IV prolapse. The average age was 58.8 years (+/- 12.1), with a median parity of 3. Forty-eight percent were postmenopausal and taking estrogen, 27% were postmenopausal and not taking estrogen, and 25% were premenopausal. Patients who had stress incontinence symptoms had less advanced prolapse (median 5 cm less prolapse in the apical compartment) than patients without stress incontinence. Women who required manual assistance to urinate had more advanced prolapse (median 3.5 cm more prolapse in the most advanced compartment) than those who did not. Patients with urinary urgency and urge incontinence also had less advanced prolapse, although the differences were smaller than for stress incontinence (median 3 cm difference or less). There were no clinically significant differences in any compartment for symptoms related to sexual or bowel function. Women with more advanced prolapse were less likely to have stress incontinence and more likely to manually reduce prolapse to void; however, prolapse severity was not associated with sexual or bowel symptoms. II-2.
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                Author and article information

                Journal
                Ethiop J Health Sci
                Ethiop J Health Sci
                Ethiopian Journal of Health Sciences
                Research and Publications Office of Jimma University (Jimma, Ethiopia )
                1029-1857
                July 2012
                : 22
                : 2
                : 85-92
                Affiliations
                [1 ]Department of Surgery, college of public health and medical sciences, Jimma University
                [2 ]Department of obstetrics and gynecology, college of public health and medical sciences, Jimma University,
                Author notes
                *Corresponding Author: email- hmullu@ 123456yahoo.com
                Article
                jEJHS.v22.i2.pg85
                3407830
                22876071
                bb1f3f3f-7639-4772-a95e-c9aac1787e13
                Copyright © Jimma University, Research & Publications Office 2012
                History
                Categories
                Original Article

                Medicine
                pelvic organ prolapse,uterovaginal prolapse,vaginal hysterectomy
                Medicine
                pelvic organ prolapse, uterovaginal prolapse, vaginal hysterectomy

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