Isolated posterior vaginal defect is one of the entities among pelvic organ prolapse and is considered to have a different pathophysiologic background than other forms of pelvic organ prolapse. Although anterior wall prolapse is most commonly studied in the literature, it has been determined that posterior wall prolapse has a significantly higher prevalence in specific region of the world.(1) The reasons behind this remain unclear in the current literature, however, the associations between obstructive defecation and posterior wall prolapse seem to be increasingly studied throughout the world, as global diets are changing with incredible speed. The current literature regarding chronic obstructive defecation and pelvic organ prolapse has not yet determined the cause and effect relationship between the two, or whether they are independent but concurrent problems. Our aim was to evaluate the relationship between bowel dysfunction and diet to isolated posterior compartment prolapse (IPCP).

This cross-sectional study compared the dietary outcomes of Irish and Israeli women who underwent pelvic organ prolapse repair surgery between August 2020 and October 2021. Patients were asked to complete a validated Mediterranean diet questionnaire and a Patient Assessment of Constipation-Symptoms (PAC-SYM) questionnaire over the phone.(2)

During the study period a total of 236 participants were enrolled and thirty two patient were dropped out without answering the Questionnaires. Among the two hundred and four patients, 108 (52.9%) patients adhered to the Mediterranean diet, and 96 (47.0%) did not. It was found that in the non-Mediterranean diet patients, increased symptoms of constipation (p=0.047) and higher BMI (p=0.0008) were significant more prevalent. The non-Mediterranean diet group had a significant higher prevalence of patients with class III obesity (BMI >39.9) (p=0.047) when compared to the Mediterranean diet group. Surgical repair of the posterior compartment, both combined (26(24%) Vs. 37(38.5%), p=0.033) and isolated (6(5.5%) Vs. 15(21.7%), p=0.021), were more prevalent amongst the non-Mediterranean diet group. Prolapse of all compartments except the apical compartment was found to be more prevalent in the non-Mediterranean diet group.

Mediterranean diet displays a lower prevalence of posterior vaginal defect, both isolated and combined. This was demonstrated by the inverse relationship found between adherence to Mediterranean diet, decreased symptoms of constipation, and lower BMI values amongst this group. We found a direct link between the demographic diet, constipation and and the degree and prevalence of posterior compartment defect.

Adherence to the Mediterranean diet and subsequent bowel dysfunction is a significant contributory factor to the prolapse of the posterior vaginal compartment.

Haya N, Baessler K, Christmann-Schmid C, de Tayrac R, Dietz V, Guldberg R, et al. Prolapse and continence surgery in countries of the Organization for Economic Cooperation and Development in 2012. Am J Obstet Gynecol 2015;212: 755.e1-27.
Arya LA, Novi JM, Shaunik A, Morgan MA, Bradley CS. Pelvic organ prolapse, constipation, and dietary fiber intake in women: A case-control study. Am J Obstet Gynecol. 2005;192(5 SPEC. ISS.). doi:10.1016/j.ajog.2004.11.032

Continence 2S2 (2022) 100380
DOI: 10.1016/j.cont.2022.100380