Pelvic organ prolapse (POP), or urogenital prolapse, is a common health problem associated with pelvic floor dysfunction amongst women 1 and was found to be more prevalent in low-income countries. 2 It is estimated that POP can affect as many as 50% of adult women over the age of 40 years 3 with a 13% lifetime risk of undergoing surgery. 4–6
Well-documented risk factors for all three POP compartments include older age, obesity, pregnancy, vaginal delivery, high parity, previous hysterectomy, and chronic obstructive defecation. It has been established that prolapse of the anterior compartment is the most common type, being two times more prevalent than posterior prolapse and three times more prevalent than apical prolapse. 7 However, it has been determined that posterior wall prolapse has a different prevalence among different countries, with a significantly higher prevalence (48.2%) in Ireland than in other Western countries, such as the United States of America (38.4%) and Germany (33.2%). 8
The reasons behind this remain unclear in the current literature; however, these associations seem to be linked 9–11 and are increasingly studied worldwide as global diets change. With a rise in carbohydrate and salt-rich foods and a widespread decrease in grains, cereals, and other fibrous foods, there seems to be a “nutrition transition” rapidly evolving with the rise in urbanization. 12 The traditional Mediterranean diet (MD) is inversely associated with obesity risk or weight gain 13–15 and is well known to improve bowel function. 16
Low adherence Mediterranean diet and obesity
Numerous studies 14,17,18 showed that MD adherence was associated with a significantly lower likelihood of becoming obese which remains similar amongst (odds ratios with 95% CI) women (0.69, 0.54-0.89) and men (0.68, 0.53-0.89). 14
Obesity and pelvic organ prolapse
Pandey and Bhattacharya 19 found a significant correlation between female POP and the severity of obesity. POP was most prevalent amongst morbidly obese (53%) participants (BMI >39.9) and considerably higher (44%) in severely obese (BMI 35) than obese (BMI 30) women.
Mediterranean diet, constipation, and pelvic organ prolapse
While research on the associations between chronic constipation and POP in women has increased in recent years, there has yet to be a conclusive finding as to the direction of this causal relationship. It is unclear whether chronic constipation and straining predispose an individual to POP 20 or if the low Adherence to the Mediterranean diet (LAMD) results in defecatory obstructions and eventual chronic constipation. Varma and colleagues 20 determined that women who had constipation symptoms on a weekly basis were significantly more likely to have POP. Women who had undergone hysterectomies or POP surgeries had a two times greater risk of developing weekly obstructive defecation.
Numerous studies 9–11,21 focused on the relation of a low fiber diet and constipation to pelvic organ prolapse and the link to the posterior compartment. Furthermore, it was determined that the prevalence of posterior prolapse is much greater in constipated women than in prolapse of any other compartment. 22 In contrast, Handa et al. 23 found that defecatory symptoms are not significantly more likely to develop among asymptomatic women with posterior vaginal prolapse than in asymptomatic women without such prolapse. Although, defecatory symptoms were associated with a more rapid worsening of posterior support (difficulty with bowel movements, P=.005; splinting, P=.057). 23
Soligo and colleagues 22 determined that anterior prolapse was less common in constipated women than posterior prolapse.
Current data from the literature support the correlation between LAMD and pelvic organ prolapse, especially the posterior compartment’s prolapse. As there is a direct relationship between impaired bowel function and POP, it is requested that diet habits will also influence this problem.
We have recently finished a largescale study that shows this direct relationship between posterior prolapse which was linked to LAMD. In this study, 73% of the Irish population in the study cohort showed low adherence to the Mediterranean diet, and almost 50% had some degree of impaired bowel function.
Women should be educated about this relationship, as adherence to the Mediterranean diet may decrease POP prevalence in this population.
References available on request
Written by Yair Daykan, The department of Obstetrics and Gynecology, Cork University Maternity Hospital, Cork, Ireland and Barry O’Reilly, The department of Obstetrics and Gynecology, Cork University Maternity Hospital, Cork, Ireland
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