CORRELATION OF PELVIC ORGAN PROLAPSE QUANTIFICATION TECHNIQUE WITH PELVIC FLOOR DYSFUNCTION SYMPTOMS Affiliation

Methodology A prospec ve study was done from March 2014 to February 2015 a er ethical approval from IRC, B.P. Koirala Ins tute of Health Sciences. All pa ents with pelvic organ prolapse were included a er informed verbal consent. The pa ents were then asked ques ons as in pelvic floor distress inventory ques onnaire (PFDI) and noted in performa. The pa ents were then examined by POP-Q technique and noted. The informa ons were entered in the MS excel chart and sta s cal analysis done using SPSS 11.5.


Objec ve
To assess pelvic organ prolapse by POP-Q technique and to correlate pelvic floor distress inventory ques onnaire with POP-Q segments.

Methodology
A prospec ve study was done from March 2014 to February 2015 a er ethical approval from IRC, B.P. Koirala Ins tute of Health Sciences.All pa ents with pelvic organ prolapse were included a er informed verbal consent.The pa ents were then asked ques ons as in pelvic floor distress inventory ques onnaire (PFDI) and noted in performa.The pa ents were then examined by POP-Q technique and noted.The informa ons were entered in the MS excel chart and sta s cal analysis done using SPSS 11.5.

Results
There were 72 pa ents enrolled.The mean age of pa ents was 53.65 years.Majority of pa ents were found to have stage 4 prolapse (43.1%).
POP-Q examina on showed majority of pa ents had anterior and apical compartment defect.Correla on between POP-Q points and urinary symptoms showed significant rela on with points in anterior compartment, genital hiatus and perineal bodies.Correla on with POP-Q points with colorectal symptoms showed involvement of genital hiatus significantly with strain stool and incomplete bowel movement.Correla on with pelvic distress symptoms with POP-Q sites showed significant rela on with bulging, push up vagina for urina on and defeca on.

Conclusion
POP-Q site specific points showed significant correla on with symptoms from Pelvic Floor Distress Inventry (PFDI) ques onnaires.

INTRODUCTION
Pelvic organ prolapse (POP) is a common, benign condi on in women.For many women it can cause vaginal bulge and pressure, voiding dysfunc on, defecatory dysfunc on, and sexual dysfunc on, which may adversely affect quality of 1 life.Pelvic organ prolapse is the health concern affec ng millions of women worldwide.The global burden of disease 2010 reported recently the es mated prevalence of POP to  posterior compartment plo ed in three by three grids, which helps in correla ng with pelvic floor dysfunc on symptom and further helps in pre-opera ve planning for site specific pelvic floor reconstruc on.It can also be used for post-opera ve assessment by comparing with preopera ve site-specific measurements of pelvic organ prolapse.The objec ve of the study was to assess pelvic organ prolapse by POP-Q technique and to correlate pelvic floor distress inventory ques onnaire with POP-Q measurements.

METHODOLOGY
This is a prospec ve study done from March 2014 to February 2015 a er ethical approval from Ins tu onal Review Commi ee (IRC), B.P.Koirala Ins tutes of Health Sciences (BPKIHS).All pa ents with pelvic organ prolapse were included a er informed verbal consent.The pa ents were explained regarding the study and briefed about ques onnaires in na ve language.The pa ents were then asked quality of life ques onnaires regarding urinary symptoms, colo-rectal symptoms and pelvic distress symptoms due to pelvic organ prolapse as in pelvic floor distress inventory ques onnaire (PFDI) and noted in performa.The pa ents were then examined for pelvic organ prolapse by POP-Q technique by trained gynaecologist and noted.
The informa on was entered in the MS excel chart and sta s cal analyses were done using SPSS 11.5.Frequency and means were calculated for demographic variables.Chi-square test and pearsons' correla on test was applied for assessing rela ons between POP and pa ents symptoms from PFDI.Level of significance was considered to be p<0.05.

RESULTS
There were 72 pa ents enrolled during study dura on.The age of pa ent ranged from 26-75 years.The mean age of pa ents was 53.65 years.Among 72 pa ents 57 (79.2%) were post menopausal.Fi y-three (73.6%) had more than two children and majority pa ents were found to have stage 4 pelvic organ prolapse (43.1%).
POP-Q examina on showed majority of pa ents had anterior and apical compartment defect involving points Aa, Ba, C (Table .1).Correla on between POP-Q points and urinary symptoms like urge incon nence, dribbling, difficulty in evacua ng bladder and pain lower abdomen showed significant rela on with defect in anterior compartment, genital hiatus and perineal bodies in POP-Q.Increased frequency and dribbling also showed significant rela on with point D (Table .2).Colorectal-Anal symptoms didn't show significant rela on with most POP-Q sites except genital hiatus measurement was significantly related with straining for stool and incomplete bowel movement (Table .3).Correla on with pelvic distress symptoms with POP-Q points showed significant rela on with bulging symptoms with involvement of anterior, apical aswell as posterior vaginal segments.Requiring pushing up vagina for defeca on showed involving Ba, C and Bp.Defect in perineal body in POP-Q showed pa ents to have symptoms of incomplete voiding sensa on and requiring pushing up vagina during urina on (Table.4).

DISCUSSION
Out of 72 pa ents enrolled, POP-Q examina on showed majority of pa ents to have grade 4 pelvic organ prolapse mostly involving anterior and apical compartment.Pelvic Organ Support Study (POSST) described the distribu on of pelvic organ support in a gynecologic clinic popula on to define the clinical disease state of pelvic organ prolapse and to analyze its epidemiologic condi on.The popula on consisted of 1004 women who were aged 18 to 83 years.The prevalence of pelvic organ prolapse quan fica on stages was 24% (stage 0), 38% (stage 1), 35% (stage 2), and 2% (stage 3).In contrast, our study showed 12 majority of pa ents with stage 4 pelvic organ prolapse.
Study done on func onal symptoms and associa ons of women with genital prolapse showed SUI, urgency, and voiding difficul es as common urinary symptoms and defecatory dysfunc on, anal incon nence as colo-rectal symptom and anterior vaginal wall prolapse were found the most common.Similar to our study, anterior segment prolapse was found to be common and significant correla on was found between push up on the bulge to 13 ini ate or complete urina on and point Gh and Pb.
The rela onship of vaginal prolapse severity to symptoms and quality of life showed the stage of prolapse was significantly higher in those symptoma c of prolapse.There was no correla on between urinary symptoms and uterovaginal prolapse severity whereas bowel symptoms were strongly associated with posterior vaginal wall prolapse.This result is contrary to our result where we found the rela onship between bladder symptoms and 14 POP-Q points.
Extent of uterovaginal prolapse when compared with bowel dysfunc on symptoms with ques onnaires showed no 15 rela on with the severity of posterior vaginal prolapse.
Study done on func onal bowel and anorectal disorders in pa ents with pelvic organ prolapse and incon nence showed, there was a high prevalence of cons pa on and anorectal pain disorders in women with urinary incon nence and pelvic organ prolapse.However, pa ents with stage 3 or 4 pelvic organ prolapse had similar rates of cons pa on compared with those with urinary incon nence.Cons pa on and its subtypes were not related to the stage of pelvic organ prolapse.It appeared that either cons pa on was not a significant contributor to prolapse, or cons pa on contributes equally to the development of both urinary incon nence and pelvic organ women were studied to determine whether vaginal descent changes were associated with pelvic floor symptoms in postmenopausal women.Increasing apical descent (point C) was associated with "see/feel a bulge", increasing anterior descent (point Ba) with bladder pain and obstruc ve bladder scores, and increasing posterior 17 descent (point Bp) with the bowel incon nence score.Most of the result were similar to our result except posterior descent and bowel incon nence.

CONCLUSION
Pelvic Floor Distress Inventory (PFDI) ques onnaire and POP-Q points showed significant rela on with various pelvic organ prolapse symptoms.However, since anterior and apical segments with were predominantly involved in POP-Q eamina on, urinary and pelvic distress symptoms showed more significant rela on than bowel dysfunc ons.

RECOMMENDATION
Though, PFDI and POP-Q measurements shows significant correla on in different aspects of ques onaires.Large popula on studies is requird to help in formula ng recommenda ons regarding its use in clinical prac ce.

LIMITATION OF THE STUDY
Study would have been more strong with large popula on and also if we could have followed up the pa ents postopera ve for re-ques onnaire and POP-Q examina on to evaluate the improvements in site-specific defects and in symptoms due to pelvic floor dysfunc ons.

8 women
with pelvic floor disorders.PFDI and Pelvic floor impact ques onnaire are validated ques onnaires to assess effect on health related quality of life due to prolapse, focusing on urinary symptoms, colo-rectal symptoms, 9,10 pelvic floor distress symptoms.Pelvic Organ prolapse quan fica on (POP-Q) technique is a 11 validated tool to measure pelvic organ prolapse.It helps in site-specific measurement of different compartment of prolapsed segment as anterior compartment, apical and 11

Table . 3
: Correla on between Colorectal-Anal Distress inventory 8 and POP-Q points: