Hypothesis / aims of study: Sarcopenia and Pelvic Organ Prolapse (POP) can commonly arise during aging. Sarcopenia negatively affects functionally important muscles of the limbs and trunk. It is known that normal pelvic support is mainly provided by the levator ani muscles and connective tissue attachments of the vagina on the side walls and in the pelvis. When damaged, these muscles become more vertical in orientation and the vaginal opening increases. Therefore, we aimed to investigate the association between sarcopenia and the severity of POP.

Study design, materials, and methods: This is a cross-sectional study carried out in two urogynecology outpatient clinics located in Fortaleza, Ceará, Brazil, from February to September 2019. The sample consisted of 217 elderly women monitored in the outpatient clinics. Elderly women with cognitive alterations, amputations or fractures in the upper and/or lower limbs that prevented the performance of the proposed tests were excluded. POP severity was assessed using the Pelvic Organ Prolapse Quantification System (POP-Q). To establish the diagnosis of sarcopenia, muscle strength and muscle mass were assessed using a hydraulic hand dynamometer and calf circumference, respectively, to perform the measurements. The data were grouped using Research Electronic Data Capture (RedCap) and analyzed using the statistical program Statistical Package for the Social Sciences, version 24.0. The project was submitted to the research ethics committee of the services where the data were collected, with approval under opinions No. 3,159,390 and No. 3,270,489. The recommendations expressed by the Brazilian legislation on research with human beings were followed.

Results: The elderly women were, on average, 69.51 ± 6.75 years old. Women were married or in a stable relationship (n = 93; 42.9%), mixed race (n = 151; 69.6%), Catholic (n = 150; 69.1%), and retired or receiving benefits (n = 171; 78.8%). Most women (n = 156; 71.9%) had POP and a few (n = 25; 11.5%) had sarcopenia. Regarding the association between the severity of prolapse and sarcopenia, the elderly women in both groups had a median of 3.0. However, POP severity was increased in elderly women with sarcopenia (p25 3.0 - p75 4.0), differing from the elderly women who did not have the disease, in which the percentile varied between 1.0 and 3.0, with a significant difference between the groups (p = 0.002).

Interpretation of results: Our results showed that sarcopenia was associated with more severe stages of pelvic organ prolapse. To our knowledge this is the first study to assess the presence of sarcopenia in women with POP. It is expected that the findings described above will bring contributions to the current knowledge of the topic and will be able to extrapolate geographical barriers, since they add data to the limited literature investigating the association of sarcopenia with pelvic floor dysfunctions.

Concluding message: Severe pelvic organ prolapse was increased in women with sarcopenia. This is of significant interest for public health and provide information unknown to the region of the study and to both gerontology and urogynecology fields. In addition, this study can influence the development of intervention research, actions to prevent sarcopenia and health promotion for the elderly.