Hypermobility Spectrum Disorders: An Important Cause of Pelvic Organ Prolapse in Nulliparous Women 

James Trotta MD DRANZCOG[1], Mugdha Kulkarni MBBS FRANZCOG1, Payam Nikpoor MD FRANZCOG1 

Pelvic organ prolapse (POP) is the herniation of pelvic viscera into or through the vagina (1). Women with a family history of genital prolapse are more likely to develop prolapse, suggesting a genetic component (2). It has been observed that connective tissue abnormalities such as benign hypermobility spectrum disorders are associated with genital prolapse (3).

Case: A twenty-five-year-old nulliparous woman presented to pelvic floor unit outpatients with bothersome symptoms of full thickness rectal prolapse and uterovaginal prolapse on a background of a failed Delormes procedure. Symptoms included: Rectal bleeding, vaginal bulge, dyspareunia and pelvic pain. Conservative pelvic floor physiotherapy had failed. The patient also complained of symptoms of hypermobility including hip and jaw subluxation and hypermobile digits. Medical history included fructose intolerance and depression. Examination revealed a full thickness rectal prolapse and stage three uterovaginal prolapse. Beighton score for hypermobility, presence of piezogenic papules and unusually soft skin confirmed the diagnosis of hypermobility spectrum disorder. With a strong preference for definitive management, the patient elected for a combined urogynaecology/colorectal laparoscopic ventral biological graft rectopexy and laparoscopic biological graft sacro-hysteropexy. The patient was symptom-free at the 10-week post-operative review. She was advised to elect for a caesarean section in any future pregnancies. 

Conclusions: In nulliparous women presenting with POP, investigations for connective tissue disorders should be considered. Women with connective tissue disorders are at a higher risk of recurrent prolapse and definitive surgical management should be considered. 

References:
1.         Lim VF, Khoo JK, Wong V, Moore KH. Recent studies of genetic dysfunction in pelvic organ prolapse: the role of collagen defects. Aust N Z J Obstet Gynaecol. 2014 Jun;54(3):198-205. doi: 10.1111/ajo.12169. Epub 2014 Feb 25. PMID: 24575973.

2.         Lince SL, van Kempen LC, Vierhout M, Kluivers KB. A systematic review of clinical studies on hereditary factors in pelvic organ prolapse. Int Urogynecol J 2012; 23: 1327– 1336

3.         Altman D, Forsman M, Falconer C, Lichtenstein P. Genetic influence on stress urinary incontinence and pelvic organ prolapse. Eur Urol 2008; 54: 918–9232.

 

[1] Monash Women’s and Newborn, Monash Health, Melbourne, Australia.