Premenopausal women with pelvic organ prolapse and pelvic floor symptoms at a tertiary hospital in Thailand: a retrospective cohort study

Abstract

Aim: Pelvic organ prolapse (POP) primarily affects older women, with limited data on premenopausal cases, especially among Asians. Severe pelvic floor symptoms, including urinary, bowel, and sexual dysfunction, remain understudied in this population. This study aimed to describe symptom severity and treatment outcomes in premenopausal POP patients. Methods: A retrospective cohort study was conducted on premenopausal POP patients at a university hospital over six years. The Pelvic Floor Bother Questionnaire (PFBQ) assessed symptom severity, and treatment outcomes were evaluated over two years. Data were presented as counts with percentages or means with standard deviations. Results: Among 87 women (mean age 44.8 ± 4.9 years), 12 (13.8%) had stage I, 47 (54.0%) stage II, 24 (27.7%) stage III, and 4 (4.6%) stage IV POP. Common comorbidities included dyslipidemia (13.8%), diabetes mellitus (11.5%), and thyroid disease (10.3%). Six patients had connective tissue diseases or nerve damage. Premenopausal women accounted for approximately 5.6% (87 out of 1,567) of all new POP cases in this population. The most bothersome symptoms were prolapse bulging (83.9%), urinary frequency (58.6%), and urgency (49.4%). Treatment included pelvic floor muscle training (10%), pessary use (28%), and surgery (62%). Vaginal hysterectomy with pelvic floor repair was most common, with 8 colpocleisis cases. Symptom improvement at two years was highest after surgery (90.1%), followed by pessary (82.6%) and pelvic floor training (68.3%). Conclusion: This study highlights the burden of POP and pelvic floor symptoms in Thai women, emphasizing the need for tailored management strategies.