PELVIC ORGAN PROLAPSE AND URINARY INCONTINENCE IN NULLIPAROUS WOMEN AT THE UNITED STATES MILITARY ACADEMY

W. Larsen, MD, T. Yavorek, MD

   Objective: Our purpose was to determine the prevalence of urinary incontinence and assess the stages of pelvic support in a population of nulliparous physically active college students at the United States Military Academy.

   Material And Methods: This was an observational study of 143 female Cadets. Cadets in the freshman and sophomore classes were asked to participate in an ongoing study comparing urinary incontinence and pelvic organ support before and after attending military jump school. Each woman underwent an examination of pelvic organ support according to the standards of the pelvic organ prolapse and quantification system and filled out an incontinence questionnaire. The baseline exams were then analyzed for stages of support.

   Results: The group of women were found to be very physically active with 69.2% (99/143) exercising four or more times per week and 91.6% (131/143) working out three or more times. Additionally, 49.7% (60/131) of those spent sixty minutes or more per exercise session. Running was the most common form of exercise with 77.6% (111/143) running for at least part of their work out. Of the women examined, 50.3% (72/143) were found to be at pelvic prolapse stage 0 and 49.7% (71/143) were found to be at stage I. Of those women having prolapse, 93.1% (67/72) had defects in points Aa or Ba while only 5/72 patients (6.9%) had isolated defects in Ap or Bp. Of the anterior compartment defects, however, the majority were isolated to point Ba with 67% (45/67) of the women having Ba as their sole point of relaxation. The average values of the genital hiatus, perineal body, and total vaginal length were 2.5cm, 3.2cm, and 8.5cm respectively. There was a total of 27/143 (18.8%) women who repo! rted recurrent incontinence with the largest percentage (44%) being stress incontinence by history. Only one patient reported pad use due to incontinence, and none of the women felt that urine loss constituted a problem.

   Conclusion: Fifty percent of nulliparous Cadets had stage I prolapse on standardized pelvic support examination primarily in the anterior compartment. A small percentage admitted to incontinence at the time of exam. This study indicates that trauma from physical activity might cause pelvic support defects which could predispose women to incontinence problems later in life. Because the percentage of women who exercise and participate in sports is increasing, it is important to determine what effect this increase has on pelvic support. The prospective cohort continuation of this study will attempt to provide more answers.

   Key Words: nulliparous, pelvic organ prolapse, incontinence