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Functional pelvic floor anatomy in Nepali women attending a general gynaecology clinic

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Abstract

Introduction and hypothesis

Limited existing evidence suggests that there is a high prevalence of female pelvic organ prolapse (POP) amongst Nepali women. However, to date, no comprehensive assessment of pelvic floor functional anatomy has been undertaken in this population. Our study aimed to determine functional pelvic floor anatomy in Nepali women attending a general gynaecology clinic.

Methods

One hundred and twenty-nine consecutive women attending the clinic were offered an interview, clinical examination [International Continence Society Pelvic Organ Prolapse Quantification system (ICS/POP-Q)] and 4D translabial ultrasound (TLUS). Most presented with general gynaecological complaints. Five were excluded due to previous pelvic surgery, leaving 124.

Results

A POP-Q exam was possible in 123 women, of whom 29 (24%) were diagnosed with a significant cystocele, 50 (41%) significant uterine prolapse and seven (6%) significant posterior compartment prolapse. Evaluation of 4D TLUS data sets was possible in 120 women, of whom 25 (21%) had a significant cystocele, 45 (38%) significant uterine prolapse and ten (8%) significant descent of the rectal ampulla. In 13 cases, there was a rectocele with a mean depth of 14 (10–28) mm. Of 114 women in whom uterine position could be determined, 68 (60%) had a retroverted uterus associated with significant uterine prolapse (P 0.038).

Conclusions

POP is common in Nepali women attending a general gynaecology clinic, with a high prevalence of uterine prolapse (40%). Uterine retroversion was seen in 60% and was associated with uterine prolapse. Patterns of POP in Nepal seem to be different from patterns observed in Western populations.

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Abbreviations

ICS/POP-Q:

International Continence Society, Pelvic Organ Prolapse Quantification system

TLUS:

4D Translabial ultrasound

POP:

Pelvic organ prolapse

VAS:

Visual analogue scale

PFM:

Pelvic floor muscle

PFMC:

Pelvic floor muscle contraction

LAM:

Levator ani muscle

EAS:

External anal sphincter

SP:

Symphysis pubis

COPD:

Chronic obstructive pulmonary disease

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Acknowledgements

The authors thank the women who participated in this study. We also thank staff at Kathmandu Model Hospital for their assistance and generosity with their limited space. We are especially grateful to Dr. Vishal Kumar Trivedi for excellent assistance during data collection.

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Authors and Affiliations

  1. Department of Obstetrics, Gynecology & Neonatology, Sydney Medical School Nepean, The University of Sydney, 62 Derby Street, Kingswood, NSW, 2747, Australia

    Friyan Turel & Hans Peter Dietz

  2. The University of Sydney, Australia, Sydney, Australia

    Delena Caagbay

Authors
  1. Friyan Turel
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  2. Delena Caagbay
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  3. Hans Peter Dietz
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Correspondence to Friyan Turel.

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Conflict of interest

H.P. Dietz has received unrestricted educational grants from GE Medical. F. Turel and D. Caagbay have no conflict of interest to declare.

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Turel, F., Caagbay, D. & Dietz, H.P. Functional pelvic floor anatomy in Nepali women attending a general gynaecology clinic. Int Urogynecol J 29, 1435–1440 (2018). https://doi.org/10.1007/s00192-017-3534-x

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  • DOI: https://doi.org/10.1007/s00192-017-3534-x

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