DOI: 10.1177/15409996261478679 ISSN: 1540-9996

Pelvic Organ Prolapse and Alpha-1 Antitrypsin Deficiency

Erika Fuchs, Jennifer Cera, Kristen E. Holm, Charlie Strange, Robert Sandhaus, Isuzu Meyer, Alexandra J. Hergenrader, Derek Kruse, Immad Munawar, Yeongjin Gwon, Stephen I. Rennard
Show PDF Cite

Background:

Alpha-1 antitrypsin deficiency (AATD) is a genetic condition that increases the risk of emphysema and chronic obstructive pulmonary disease (COPD). Increased intra-abdominal pressure associated with chronic cough and damage to connective tissues that support pelvic organs suggest an association between COPD and pelvic organ prolapse (POP), a condition with estimated population prevalence of 3–6%. This study examined the prevalence of symptomatic POP among women with AATD.

Methods:

Women ≥18 years with AATD were invited to participate in a survey in 2025. The Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6) assessed POP. Data were linked to previous survey responses including age, AATD genotype, the Chronic Airways Assessment Test (CAAT), body mass index, smoking, employment, lung disease, alpha-1 antitrypsin augmentation prescribed, and sleep apnea. Dichotomized POPDI-6 scores (>17 versus ≤17) were assessed by participant characteristics using chi-squared tests, Fisher’s exact tests, Wilcoxon–Mann–Whitney tests, and logistic regression.

Results:

Of those invited to participate, 921 (36.1%) individuals completed the survey. POPDI-6 scores ( n = 917) were right-skewed, and 22.1% reported significant symptom distress (POPDI-6 > 17). There were significant differences in dichotomized POPDI-6 scores by age, sleep apnea, hysterectomy, surgery, number of vaginal births, and AATD genotype. Women with POPDI-6 >17 had higher overall and cough CAAT scores than those ≤17. No significant differences emerged for other characteristics. In adjusted logistic regression, there were increased odds of POPDI-6 >17 with three or more vaginal births, a diagnosis of sleep apnea, increasing CAAT score, and a genotype of MZ, but decreased odds of POPDI-6 >17 with increasing age.

Conclusions:

The prevalence of POP among women with AATD was higher than that estimated in the general population. Further studies are warranted to confirm this observation. Screening of women with AATD for POP may be an opportunity to identify needs for pelvic floor therapy and education.

More from our Archive