Skip to main content

Advertisement

SpringerLink
Log in

Pelvic organ prolapse and the lower urinary tract: The Relationship of vaginal prolapse to stress urinary incontinence

  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Vaginal prolapse and urinary incontinence frequently coexist. Rather than having a cause-and-effect relationship, these two common problems share etiologic factors. Specific tissue and functional deficiencies resulting in prolapse also are significant contributors to lower urinary tract symptoms, particularly stress urinary incontinence. This article reviews this relationship, the etiologic factors, and aspects of the clinical evaluation of the patient with prolapse and stress urinary incontinence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Delancey JO: Anatomy of the female bladder and urethra. In Ostergard’s Urogynecology and Pelvic Floor Dysfunction, edn 5. Edited by Bent AE, Ostergard DR, Cundiff GW, Swift SE. Philadelphia: Lippincott Williams & Wilkins; 2003:3–18.

    Google Scholar 

  2. Rogers RM: Anatomy of pelvic support. In Ostergard’s Urogynecology and Pelvic Floor Dysfunction, edn 5. Edited by Bent AE, Ostergard DR, Cundiff GW, Swift SE. Philadelphia: Lippincott Williams & Wilkins; 2003:19–34.

    Google Scholar 

  3. Weber AM, Walters MD: Anterior vaginal prolapse: review of anatomy and techniques of surgical repair. Obstet Gynecol 1997, 89:311–318.

    Article  PubMed  CAS  Google Scholar 

  4. Tunn R, DeLancey JO, Howard D, et al.: Anatomic variations in the levator ani muscle, endopelvic fascia, and urethra in nulliparas evaluated by magnetic resonance imaging. Am J Obstet Gynecol 2003, 188:116–211.

    Article  PubMed  Google Scholar 

  5. Delancey JO: Fascial and muscular abnormalities in women with urethral hypermobility and anterior vaginal wall prolapse. Am J Obstet Gynecol 2002, 187:93–99.

    Article  PubMed  Google Scholar 

  6. Mostwin JL: Current concepts of female pelvic anatomy and physiology. Urol Clin North Am 1991, 18:175–195.

    PubMed  CAS  Google Scholar 

  7. Richardson AC, Lyon JB, Williams NL: A new look at pelvic relaxation. Am J Obstet Gynecol 1976, 126:568–573.

    PubMed  CAS  Google Scholar 

  8. Segal JL, Vassallo BJ, Kleeman SD, et al.: Paravaginal defects: prevalence and accuracy of preoperative detection. Int Urogynecol J Pelvic Floor Dysfunct2004, 15:378–383.

    Article  PubMed  Google Scholar 

  9. Bump RC, Mattiasson A, Bo K, et al.: The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996, 175:10–17. The original description of the POP-Q system. As the literature-standard for reporting prolapse, the POP-Q should be understood.

    Article  PubMed  CAS  Google Scholar 

  10. Hall AF, Theofrastous JP, Cundiff GW, et al.: Interobserver and intraobserver reliability of the proposed International Continence Society, Society of Gynecologic Surgeons, and American Urogynecologic Society pelvic organ prolapse classification system. Am J Obstet Gynecol 1996, 175:1467–1470.

    Article  PubMed  CAS  Google Scholar 

  11. Sze EH, Jones WP, Ferguson JL, et al.: Prevalence of urinary incontinence symptoms among black, white, and Hispanic women. Obstet Gynecol 2002, 99:572–575.

    Article  PubMed  Google Scholar 

  12. Tapp K, Connolly AM, Visco AG: Evaluation of Aa point and cotton-tipped swab test as predictors of urodynamic stress incontinence. Obstet Gynecol 2005, 105:115–119.

    PubMed  Google Scholar 

  13. Strohbehn K, Jakary JA, DeLancey JO: Pelvic organ prolapse in young women. Obstet Gynecol 1997, 90:33–36.

    Article  PubMed  CAS  Google Scholar 

  14. Handa VL, Panna HK, Siddique S, et al.: Architectural differences in the bony pelvis of women with and without pelvic floor disorders. Obstet Gynecol 2003, 102:1283–1290.

    Article  PubMed  Google Scholar 

  15. Smith AR, Hosker GL, Warrell DW: The role of pudendal nerve damage in the aetiology of genuine stress incontinence in women. Br J Obstet Gynaecol 1989, 96:29–32.

    PubMed  CAS  Google Scholar 

  16. Allen RE, Hosker GL, Smith AR, Warrell DW: Pelvic floor damage and childbirth: a neurophysiologic study. Br J Obstet Gynecol 1990, 97:770–779.

    CAS  Google Scholar 

  17. Smith AR, Hosker GL, Warrell DW: The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolapse and stress incontinence of urine: a neurophysiologic study. Br J Obstet Gynaecol 1989, 96:24–28.

    PubMed  CAS  Google Scholar 

  18. Boreham MK, Wai CY, Miller RT, et al.: Morphometric analysis of smooth muscle in the anterior vaginal wall of women with pelvic organ prolapse. Am J Obstet Gynecol 2002, 187:56–63.

    Article  PubMed  Google Scholar 

  19. Ozdegirmenci O, Karslioglu Y, Dede S, et al.: Smooth muscle fraction of the round ligament in women with pelvic organ prolapse: a computer-based morphometric analysis. Int Urogyencol J Pelvic Floor Dysfunct 2005, 16:39–43.

    Article  Google Scholar 

  20. Liapis A, Bakas P, Pafiti A, et al.: Changes of collagen type III in female patients with genuine stress incontinence and pelvic floor prolapse. Eur J Obstet Gynecol Reprod Biol 2001, 97:76–79.

    Article  PubMed  CAS  Google Scholar 

  21. Goh JT: Biomechanical and biochemical assessments for pelvic organ prolapse. Curr Opin Obstet Gynecol 2003, 15:391–394. A useful review of pelvic floor biomechanical considerations.

    Article  PubMed  Google Scholar 

  22. Wong MY, Harmanli OH, Agar M, et al.: Collagen content of nonsupport tissue in pelvic organ prolapse and stress urinary incontinence. Am J Obstet Gynecol 2003, 189:1597–1600.

    Article  PubMed  CAS  Google Scholar 

  23. Goh JT: Biomechanical properties of prolapsed vaginal tissue in pre- and postmenopausal women. Int Urogyencol J Pelvic Floor Dysfunct 2002, 13:76–79.

    Article  CAS  Google Scholar 

  24. Jackson SR, Avery NC, Tarlton JF, et al.: Changes in metabolism of collagen in genitourinary prolapse. Lancet 1996, 347:1658–1661.

    Article  PubMed  CAS  Google Scholar 

  25. Chen BH, Wen Y, Li H, Polan ML: Collagen metabolism and turnover in women with stress urinary incontinence and pelvic prolapse. Int Urogyencol J Pelvic Floor Dysfunct 2002, 13:80–87.

    Article  CAS  Google Scholar 

  26. Carley ME, Schaffer J: Urinary incontinence and pelvic organ prolapse in women with Marfan or Ehlers-Danlos syndrome. Am J Obstet Gynecol 2000, 182:1021–1023.

    Article  PubMed  CAS  Google Scholar 

  27. Grady D, Brown J, Vintinghoff E, et al.: For the HERS Research Group. Postmenopausal hormones and incontinence: the Heart and Estrogen/Progestin Replacement Study. Obstet Gynecol 2001, 97:116–120.

    Article  PubMed  CAS  Google Scholar 

  28. Grodstein F, Lifford K, Resnick N, Curhan G: Postmenopausal hormone therapy and risk of developing urinary incontinence. Obstet Gynecol 2004, 103:254–260.

    PubMed  CAS  Google Scholar 

  29. Zhu L, Lang J, Feng R, et al.: Estrogen receptor in pelvic floor tissues in patients with stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2004, 15:340–343.

    PubMed  Google Scholar 

  30. Nygaard I: Physiologic outcome measures for urinary incontinence. Gastroenterology 2004, 126:S99-S105.

    Article  PubMed  Google Scholar 

  31. Swift SE, Tate SB, Nicholas J: Correlation of symptoms with degree of pelvic organ support in a general population of women: What is pelvic organ prolapse? Am J Obstet Gynecol 2003, 189:372–399.

    Article  PubMed  Google Scholar 

  32. Dietz HP, Haylen BT, Vancaillie TG: Female pelvic organ prolapse and voiding function. Int Urogyencol J Pelvic Floor Dysfunct 2002, 13:284–288.

    Article  CAS  Google Scholar 

  33. Coates KW, Harris RL, Cundiff GW, Bump RC: Uroflowmetry in women with urinary incontinence and pelvic organ prolapse. Br J Urol 1997, 80:217–221.

    PubMed  CAS  Google Scholar 

  34. Gardy M, Kozminski M, DeLancey J, et al.: Stress incontinence and cystoceles. J Urol 1991, 145:1211–1213.

    PubMed  CAS  Google Scholar 

  35. Walters MD, Shields LE: The diagnostic value of history, physical examination, and the Q-tip cotton swab test in women with urinary incontinence. Am J Obstet Gynecol 1988, 159:145–149.

    PubMed  CAS  Google Scholar 

  36. Mouritsen L, Larsen JP: Symptoms, bother, and POPQ in women referred with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2003, 14:122–127.

    Article  PubMed  Google Scholar 

  37. Burrows LJ, Meyn LA, Walters MD, Weber AM: Pelvic symptoms in women with pelvic organ prolapse. Obstet Gynecol 2004, 104:982–988. Relates prolapse symptomatology, including SUI, to the degree of prolapse.

    PubMed  Google Scholar 

  38. Romanzi LJ, Chaikin DC, Blaivas JG: The effect of genital prolapse on voiding. J Urol 1999, 161:581–586.

    Article  PubMed  CAS  Google Scholar 

  39. Kenton K, Shott S, Brubaker L: Vaginal topography does not correlate well with visceral position in women with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 1997, 8:336–339.

    PubMed  CAS  Google Scholar 

  40. Fleischmann N, Flisser AJ, Blaivas JG, Panagopoulos G: Sphincteric urinary incontinence: relationship of vesical leak point pressure, urethral mobility and severity of incontinence. J Urol 2003, 169:999–1002.

    Article  PubMed  Google Scholar 

  41. Zivkovic F, Tamussino K: Mechanism of postoperative urinary continence. Int Urogynecol J Pelvic Floor Dysfunct 2001, 12:199–202.

    Article  PubMed  CAS  Google Scholar 

  42. Blaivas JG, Olsson CA: Stress incontinence: classification and surgical approach. J Urol 1988, 139:727–731.

    PubMed  CAS  Google Scholar 

  43. Crystle CD, Charme LS, Copeland WE: Q-tip test in stress urinary incontinence. Obstet Gynecol 1971, 38:313–315.

    PubMed  CAS  Google Scholar 

  44. Cogan SL, Weber AM, Hammel JP: Is urethral mobility really being assessed by the Pelvic Organ Prolapse Quantification (POP-Q) System? Obstet Gynecol 2002, 99:473–476.

    Article  PubMed  Google Scholar 

  45. Caputo RM, Benson JT: The Q-tip test and urethrovesical junction mobility. Obstet Gynecol 1993, 82:892–896.

    PubMed  CAS  Google Scholar 

  46. Schaer GN, Koechli OR, Schuessler B, Haller U: Perineal ultrasound for evaluating the bladder neck in urinary stress incontinence. Obstet Gynecol 1995, 85:220–224.

    Article  PubMed  CAS  Google Scholar 

  47. Alper T, Cetinkaya M, Okutgen S, et al.: Evaluation of urethrovesical angle by ultrasound in women with and without urinary stress incontinence. Int Urogyencol J Pelvic Floor Dysfunct 2001, 12:308–311.

    Article  CAS  Google Scholar 

  48. Dietz HP, Clarke B, Herbison P: Bladder neck mobility and urethral closure pressure as predictors of genuine stress incontinence. Int Urogyn J 2002, 13:289–293.

    Article  CAS  Google Scholar 

  49. Richardson DA, Bent AE, Ostergard DR: The effect of uterovaginal prolapse on urethrovesical pressure. Am J Obstet Gynecol 1983, 146:901–905.

    PubMed  CAS  Google Scholar 

  50. Wall LL, Hewitt JK: Urodynamic characteristics of women with complete posthysterectomy vaginal vault prolapse. Urology 1994, 44:336–342.

    Article  PubMed  CAS  Google Scholar 

  51. Gallentine ML, Cespedes RD: Occult stress urinary incontinence and the effect of vaginal vault prolapse on abdominal leak point pressures. Urology 2001, 57:40–44.

    Article  PubMed  CAS  Google Scholar 

  52. Karram MM: What is the optimal anti-incontinence procedure in women with advanced prolapse and ’potential’ stress incontinence? Int Urogyencol J Pelvic Floor Dysfunct 1999, 10:1–2.

    Article  CAS  Google Scholar 

  53. Valentini FA, Besson GR, Nelson PP, Zimmern PE: A mathematical micturition model to restore simple flow recordings in healthy and symptomatic individuals and enhance uroflow interpretation. Neurourol Urodyn 2000, 19:153–176.

    Article  PubMed  CAS  Google Scholar 

  54. Mostwin JL, Genadry R, Saunders R, Yang A: Stress incontinence observed with real time sonography and dynamic fastscan magnetic resonance imaging: insights into pathophysiology. Scand J Urol Nephrol Suppl 2001, 207:94–99; discussion 106–125.

    Article  PubMed  Google Scholar 

  55. Petros P: Changes in bladder neck geometry and closure pressure after midurethral anchoring suggest a musculoelastic mechanism activates closure. Neurourol Urodyn 2003, 22:191–197.

    Article  PubMed  Google Scholar 

  56. Barbic M, Kralj B, Coer A: Compliance of the bladder neck supporting structures: importance of activity pattern of levator ani muscle and content of elastic fibers of endopelvic fascia. Neurourol Urodyn 2003, 22:269–276.

    Article  PubMed  Google Scholar 

  57. Delancey JO: Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol 1994, 170:1713–1723.

    PubMed  CAS  Google Scholar 

  58. Umek WH, Laml T, Stutterecker D, et al.: The urethra during pelvic floor contraction: observations on three-dimensional ultrasound. Obstet Gynecol 2002, 100:796–800.

    Article  PubMed  Google Scholar 

  59. Latini JM, Zimmerman MB, Kreder KJ: Association between Valsalva and cough leak point pressures and pelvic organ prolapse quantification in women with stress incontinence. J Urology 2005, 173:1219–1222.

    Article  Google Scholar 

  60. Bai SW, Jeon MJ, Kim JY, et al.: Relationship between stress urinary incontinence and pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2002, 13:256–260.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Scott Department of Urology, Scurlock 2100, 6560 Fannin Avenue, 77030, Houston, TX, USA

    Phillip P. Smith MD

Authors
  1. Phillip P. Smith MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rodney A. Appell MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Smith, P.P., Appell, R.A. Pelvic organ prolapse and the lower urinary tract: The Relationship of vaginal prolapse to stress urinary incontinence. Curr Urol Rep 6, 340–347 (2005). https://doi.org/10.1007/s11934-005-0050-1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-005-0050-1

Keywords

Search

Navigation