Pelvic Organ Prolapse in a Fighter Pilot with Alpha-1 Antitrypsin Deficiency

Few researchers have studied symptomatic younger to middle-aged women with pelvic organ prolapse. The association between highly strenuous activity and prolapse symptoms is largely theoretical. It is also known that a genetic component likely contributes to early-onset pelvic organ prolapse, but prevention and treatment with respect to this has not been explored. Service restrictions differ for active duty women who are diagnosed with symptomatic pelvic organ prolapse.

We present a case of a 33-yr-old Gravida 1 Para 1 fighter pilot who developed symptomatic pelvic organ prolapse after a vaginal delivery. Her prolapse symptoms initially prevented her from flying due to exacerbation of pain and pressure. Her exam demonstrated Stage III pelvic organ prolapse. She was treated with a course of physical therapy and ring with support pessary which allowed the patient to return to flight status after 5 mo. After completing the course of physical therapy, her physical exam improved to Stage II pelvic organ prolapse. A few months later, the patient reported that distracting vaginal pain recurred with the highest G forces. Coincidently, the patient was also diagnosed with pulmonary sequela of alpha-1 antitrypsin deficiency and disqualified from flight status.

This case illustrates the capability of decreasing pelvic organ prolapse with conservative measures, even in extreme environments, but it also identifies a possible association between an elastase activity defect and susceptibility to pelvic organ prolapse.Buckley K, Gann J, Barbier H, Greer J. Pelvic organ prolapse in a fighter pilot with alpha-1 antitrypsin deficiency. Aerosp Med Hum Perform. 2018; 89(1):66-69.