Aetiology

The aetiology of pelvic organ prolapse is multifactorial. It may be due to:

• weakness of the support structures - caused by a defect in the complex interaction between the levator ani, the vagina, and the connective tissue
• neuropathic injury - caused by stretching of the pudendal nerves that may occur during child birth

The following risk factors are associated with POP:

• established risk factors
  • higher parity
    • increasing vaginal parity was the strongest risk factor for POP in women < 60 years
  • vaginal childbirth
  • advancing age
    • prevalence of POP increases by 40% with each decade of life
  • obesity
  • previous hysterectomy
• potential risk factors
  • forceps delivery
  • other obstetric factors
    • high infant birth weight >4500 g
    • prolonged second stage of labour
    • age <25 years at first delivery
  • family history of pelvic organ prolapse
    • risk of prolapse is higher if mother or sister has prolapse
  • shape and orientation of bony pelvis
  • occupations which requires heavy lifting
  • constipation
  • connective tissue disorders
    • an association between POP and a variation of collagen type 1 gene has been reported (1,2)

Reference:

1. Kuncharapu I, Majeroni BA, Johnson DW. Pelvic organ prolapse. Am Fam Physician. 2010;81(9):1111-7
2. Barber MD. Pelvic organ prolapse. BMJ. 2016;354:i3853