The relationship between pelvic organ prolapse location, severity and symptoms of pelvic dysfunction

Pelvic organ prolapse (POP) occurs when the pelvic floor support is compromised, resulting in the downward displacement of pelvic organs from their normal anatomical positions. While the pelvic organ prolapse quantification (POP-Q) system aids in staging and treatment selection, the correlation between POP location, severity and symptom impact remains incompletely understood. The primary aim of the study was to explore the impact of prolapse location and severity on symptoms.

A prospective investigation was performed in 2020 at the Lithuanian University of Health Sciences. The study protocol included a standardized urogynecologic assessment, along with the administration of the Lithuanian prolapse quality of life (P-QOL) questionnaire to evaluate symptom severity associated with pelvic organ prolapse. Participants were categorized as symptomatic (n = 137) or asymptomatic (n = 137) based on whether they have POP symptoms. Correlation between POP symptoms and POP-Q point among symptomatic women was assessed using Spearman's rank correlation coefficient.

All higher POP-Q points were associated with bowel symptoms related to interference from a vaginal bulge. Points Ba and C were linked to obstructive urinary symptoms. Certain symptoms-such as the sensation of a vaginal bulge and vaginal discomfort, particularly when standing-correlated specifically with Ba, C, and D. In contrast, other urinary and bowel dysfunction symptoms, including urinary urgency, frequency and constipation, showed no anatomical associations.

Although most POP-related symptoms were more pronounced in the symptomatic group, not all exhibited a direct correlation with prolapse severity or specific anatomical compartments. These findings highlight the multifactorial nature of POP and emphasize the need for individualized assessment that combines anatomical evaluation with patient-reported outcomes.