Pelvic organ prolapse (POP) is a multifaceted disorder defined by the shifting of pelvic structures away from their typical anatomical location, either descending into or protruding from the vaginal passage, due to a compromise in the integrity of the supportive elements that comprise the pelvic base, including musculature, fascial components, and soft tissue networks [1]. Pelvic floor dysfunction (PFD) refers to a more extensive medical entity encompassing various anatomical and physiological disorders, including bladder control issues, bowel leakage, sexual health disturbances, and POP, stemming from impaired function of the musculature, connective tissues, and neural components forming the pelvic foundation [2]. Although POP is included in the PFD scope, it represents mechanical and anatomical weakness, whereas PFD is a more inclusive and multidimensional concept, including both functional deficiencies and structural impairments [3, 4].

The incidence of POP varies according to the diagnostic method used. While symptom-based data indicate a prevalence of 3% to 6% in the community, this rate can be as high as 40% to 50% when assessed by pelvic examination [5]. POP development is closely associated with various risk factors, such as advanced age, a high number of births, a previous record of giving birth vaginally, menopause, obesity, chronic bowel irregularities, persistent coughing, smoking, as well as previous pelvic surgeries [6, 7, 8, 9]. This multifactorial nature draws attention to the preventable aspects of POPs, increasing their importance for public health.

POP manifests itself clinically complaints like bladder and bowel control issues, pelvic discomfort, vaginal pressure, and pain during sexual intercourse, which are especially evident in postmenopausal women [10, 11]. These symptoms are not limited to physical discomfort; they also deeply influence a person’s body perception, self-worth, social relationships, as well as sexual life, leading to notable reductions in overall well-being [12]. However, many women delay seeking medical help due to embarrassment, seeing the disease as a natural consequence of aging, or misinformation and perceptions, which can lead to years of symptoms and chronic deterioration in daily functioning [13].

Although POP has a well-defined clinical picture in terms of diagnosis and treatment, the effects of the disease on the individual and the symptom profile can vary significantly depending on contextual factors such as sociodemographic characteristics, cultural norms, and access to health services. The current literature tends to ignore these differences and assess the effects of POP on a homogeneous patient group. This study aimed to assess the effects of POP on symptom burden and quality of life in a local context through the validated Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) scales and to identify modifiable risk factors and potential areas for early intervention and preventive strategies.

This study investigated the impact of POP on symptom burden and overall daily functioning through the validated and reliable PFDI-20 and PFIQ-7 scales and analyzed the associations of demographic and obstetric characteristics with POP. Age ($\ge$35 years; p 0.001), BMI ($\ge$25 kg/m²; p 0.001), WHR ($\ge$0.8; p 0.001), parity ($\ge$2; p 0.001), vaginal delivery (p 0.001), comorbidities (p 0.001) and menopause (p 0.001) significantly increased the risk of developing POP. In contrast, smokers’ risk of developing POP was significantly lower (p = 0.005). The scores obtained from the PFDI-20 and PFIQ-7 scales and their subgroups were significantly higher in women with stage II POP and above POP (p 0.001).

Increasing age is recognized as a key contributing factor to the progression of POP, often resulting in more pronounced clinical manifestations and greater interference with everyday functioning [17]. It has been reported that as age increases, PFDI-20 and PFIQ-7 scores increase, symptoms become more prominent, and quality of life becomes more negatively affected [18]. The POPDI-6 and UDI-6 scores were found to be higher, especially for conditions like pelvic floor disorders and bladder control issues [19]. Similarly, increasing scores in the UIQ-7 and POPIQ-7 subgroups indicate that individuals experience more difficulties in their social life and daily activities as they grow older [20]. Surgical and conservative treatments significantly reduce PFDI-20 and PFIQ-7 scores, alleviating clinical complaints and improving day-to-day functioning, even in the older age group [21]. In our study, in line with the literature, women aged $\ge$35 years were significantly more likely to develop POP (p 0.001). In addition, both the PFDI-20 (R² = 0.422, p 0.001) and PFIQ-7 (R² = 0.413, p 0.001) scores increased significantly with increasing age; these findings suggest that the symptom severity of symptoms and functional impairment impact due to pelvic floor dysfunction increase with age.

A high BMI and WHR not only heighten susceptibility to POP but also contribute to more advanced disease progression. The prevalence of POP can reach up to 50% in women with a BMI $\ge$30 kg/m² [22]. Furthermore, a high BMI has been shown to contribute to the worsening of POP symptoms and pessary failure [23]. Similarly, the risk of POP is increased by 30% in individuals with a WHR $\ge$0.85 [22]. In particular, POP is more common in individuals with a high BMI, which leads to higher scores in this population [23]. The negative consequences of POP on daily well-being are particularly evident in the areas of social life and physical mobility; this observation is supported by the high scores recorded in the POPDI-6 and POPIQ-7 subgroups [24, 25]. In our study, consistent with the literature, the risk of developing POP increased 1.47-fold (p 0.001) in individuals with a BMI $\ge$25 kg/m² and approximately 3-fold in those with a WHR $\ge$0.8. Furthermore, a significant increase in PFDI-20 scores (R² = 0.407, p 0.001) was observed with higher BMI and WHR. Similarly, scores on the PFIQ-7 (R² = 0.430, p 0.001) also rose notably in parallel with these anthropometric measures.

Research indicates that POP occurs more frequently in multiparous women than in nulliparous women and that, in particular, vaginal delivery significantly increases the risk of POP compared with cesarean section [26]. The need for POP surgery has been reported to increase approximately threefold in women with a parity of five or more [26], and the risk associated with vaginal delivery has been reported to range from 4.85 to 12 times greater than that associated with cesarean section [27]. Smokers have been reported to have a lower risk of POP, which has been attributed to the effects of smoking on estrogen metabolism or a lower BMI [28]. However, another study demonstrated that smoking did not have a significant protective effect on the development of POP and may even have negative effects on the pelvic floor through chronic cough [29]. In our study, consistent with the literature, the risk of developing POP increased 3.75-fold (p 0.001) in individuals with vaginal delivery and 3.38-fold (p 0.001) in individuals with a parity $\ge$2. In contrast, the risk of developing POP was significantly lower in smokers (p = 0.005). The lower risk of POP in smokers may be due to the decrease in smoking rates with increasing age.

As the severity of POP increases, its impact on patients’ physical discomfort and daily functioning increases markedly. The mean PFDI-20 score in women with stage III POP was 120 ($\pm$55), whereas this value was 80 ($\pm$40) in women with stage I POP [18]. In patients with stage IV POP, the mean PFDI-20 score was 136.6 ($\pm$54.2), indicating that the symptom burden increases significantly in advanced stages of the disease [18]. The POPDI-6, UDI-6, and PFIQ-7 subscales also reflect a greater burden of urinary and colorectal symptoms in patients with advanced POP [30]. In our study, consistent with the literature, the PFDI-20 (p 0.001) and PFIQ-7 (p 0.001) scores increased significantly with increasing POP stage.

Urinary incontinence is most common in patients with anterior prolapse, whereas defecation is difficult in patients with posterior prolapse, and vaginal fullness is common in patients with uterine prolapse. Significant increases in CRADI-8 scores have been reported, especially in women with anterior-posterior-apical (APC)-type prolapse [31]. Natural tissue repair has become preferable in POP surgery in recent years because of its anatomical and functional success. Natural tissue repair has been reported to be effective for anterior prolapse, with low recurrence rates and minimal surgical morbidity during long-term follow-up [32]. Transvaginal repairs with natural tissue in posterior prolapse provide anatomical correction and significant improvements in symptoms such as defecation problems [33, 34, 35]. In uterine prolapse, natural tissue repair offers an effective treatment option with low complication rates, high patient satisfaction, and successful anatomical results [36, 37]. It has been reported that PFDI-20 and PFIQ-7 scores, which are high before surgery, decrease significantly after surgery in women operated on for POP [38].

One of the major advantages of this study is the inclusion of an extensive participant pool and the thorough evaluation of contributing determinants related to POP. Furthermore, the use of validated scales to measure symptom severity and its impact on daily functioning increases the reliability of the findings. Few existing studies have explored symptomatology associated with POP in a sociodemographic context. This study contributes to the literature, as it is one of the few studies examining the relationships between POP and regional and cultural factors. Although the clinical assessment methods used to diagnose POP are standardized, subjective symptom reports may reveal individual differences. The cultural differences and health literacy levels of the women included in the study could influence their questionnaire responses.

In conclusion, given the substantial burden of POP on women’s health and daily functioning, early detection through regular gynecological examinations is crucial, especially in populations with high birth rates and in postmenopausal women. Annual check-ups and postpartum follow-ups can enable early recognition of POP symptoms, allowing timely intervention. These findings emphasize the importance of raising awareness of POP risk factors and implementing preventive strategies at the community level. Healthcare providers can make a significant contribution to reducing the burden of POP and improving women’s overall quality of life by promoting regular screening and addressing modifiable risk factors. This study provides valuable guidance for optimizing POP screening and prevention strategies and informs future research and clinical practice focused on improving women’s daily functioning.

Data generated and analyzed during the study are available from the corresponding author. However, such data are not publicly available.

SK, CT, AMB, DT, and CET: protocol/project development, data collection, data analysis, article writing. All authors were involved in drafting the manuscript or revising it critically for important intellectual content. All authors read and approved the final manuscript and agreed to be accountable for all aspects of the work.

The study was approved by the Non-Interventional Clinical Research Ethics Committee of the Kafkas University Faculty of Medicine (27/03/2024, 80576354-050-99/424). This study complied with the recommendations of the Declaration of Helsinki for human biomedical research. All patients or their families/legal guardians gave their informed consent for inclusion before they participated in the study.

This research received no external funding.

The authors declare no conflict of interest.