Pelvic Organ Prolapse Association with Iliopsoas Cross-Sectional Area and Muscle Strength in Middle-Aged and Older Women

INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) may result from anatomical disruption, including fascial rupture during pregnancy and childbirth, and impaired pelvic floor support. Emerging evidence suggests that POP might be associated with weakened core and lower-limb muscles. We hypothesized that POP is associated with reduced muscle strength and decreased muscle cross-sectional area (CSA). METHODS: This cross-sectional study included 55 women aged 50-70 years. Muscle strength was measured by handgrip, sit-ups, and one-leg standing with eyes open. Pelvic magnetic resonance imaging assessed the CSA of the iliopsoas, rectus abdominis, and iliac muscles, adjusted for height. Participants were grouped as 50-59 years (n = 30) and 60-70 years (n = 25) of age. RESULTS: Exercise habits were similar in the two groups. In the Activities of Daily Living questionnaire, women with POP reported reduced physical ability in daily activities. Handgrip strength and sit-up repetitions did not vary significantly, but women with POP aged 50-59 years had shorter one-leg standing time (p = 0.02). The iliopsoas CSA was smaller in women with POP in both age groups (50-59 years: p = 0.003; 60-70 years: p = 0.008). CONCLUSIONS: Younger middle-aged women with POP exhibited reduced iliopsoas CSA and impaired lower-limb balance, potentially reflecting a broader musculoskeletal vulnerability associated with aging and sarcopenia. Although this observational study had no interventions, further research should assess if early muscle weakness detection and targeted rehabilitation can improve physical function in this population.