Coexistence of Pelvic Pain, Bladder, and Bowel Symptoms in Women with Pelvic Organ Prolapse: The Effect of Transvaginal Surgery

TL;DR

This study shows that many women with pelvic organ prolapse experience coexisting pelvic pain, bladder, and bowel symptoms, which often improve after surgery.

Contribution

The study demonstrates that transvaginal surgery can significantly reduce multiple coexisting pelvic symptoms in women with pelvic organ prolapse.

Findings

Most women with pelvic organ prolapse reported moderate to severe pelvic pain and coexisting bladder and bowel symptoms.

Surgery led to significant symptom reduction, with cure rates of 65–85% for bladder symptoms and 51–85% for pain.

Fecal incontinence and obstructive defecation also improved post-surgery, with cure rates of 51–71%.

Abstract

To investigate the coexistence of pelvic pain, bladder, and bowel symptoms in women with pelvic organ prolapse (POP) and possible surgical symptom cure.

A secondary analysis of the PROPEL study (gov-Identifier: NCT00638235) data was conducted to compare symptom prevalence preoperatively vs. 6 months after transvaginal prolapse repair with Elevate anterior and/or posterior. Symptoms were assessed with the pelvic floor distress inventory questionnaire (PFDI).

Two hundred seventy-seven women with symptomatic II–IV stage POP underwent mesh-supported vaginal sacrospinous ligament fixation. Of these women, 187 (67%) reported at least one pain symptom of moderate or quite a bit severity preoperatively (anterior n = 105, visceral n = 129, posterior n = 122). Of these women reporting pain, approximately 40–64% had coexisting symptoms of urinary urgency, daytime urinary urgency, urinary urgency-incontinence, and nocturia of moderate or quite a bit severity. A smaller part reported coexisting symptoms of underactive bladder (UAB), fecal incontinence (FI), and/or obstructive defecation (OD). Six months postoperatively, a significant reduction in the prevalence of almost all symptoms was observed. Cure rates for symptoms of overactive and underactive bladder were 65–85%, for symptoms of FI and OD 51–71%, and 58% (posterior), 85% (visceral), and 82% (anterior) for pain, respectively.

The coexistence of bothersome pain, bladder, and bowel symptoms is common in women with POP. Therefore, POP should always be ruled out as a differential diagnosis before classifying the symptoms as interstitial cystitis/bladder pain syndrome. Women with POP and the co-existing symptoms described should be advised that surgical POP repair can resolve these symptoms in a high percentage.

The online version contains supplementary material available at 10.1007/s00192-025-06348-y.