# 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.

## Key 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.