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Effects of Aging on Lower Urinary Tract and Pelvic Floor Function in Nulliparous Women

From the ¹Division of Gynecology, Department of Obstetrics and Gynecology and ²Department of Urology, University of Michigan Medical Center; and ³Department of Mechanical Engineering & Applied Mechanics, Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan.

OBJECTIVE: To evaluate the effects of aging, independent of parity, on pelvic organ and urethral support, urethral function, and levator function in a sample of nulliparous women.

METHODS: A cohort of 82 nulliparous women, aged 21–70 years, were recruited from the community through advertisements. Subjects underwent pelvic examination using pelvic organ prolapse quantification, urethral angles by cotton-tipped swab, and multichannel urodynamics and uroflow. Vaginal closure force was quantified using an instrumented vaginal speculum. Subjects were grouped into five age categories and analyses performed using t tests, Fisher exact tests, Kruskal-Wallace, and Pearson correlation coefficients. Multiple linear regression modeling was performed to adjust for factors that might confound the results of our primary outcomes.

RESULTS: Increasing age was associated with decreasing maximal urethral closure pressure (r=–0.758, P<.001) with a 15-cm-H₂O decrease in pressure per decade. Pelvic organ support as measured by pelvic organ prolapse quantification did not differ by age group. Levator function as measured by resting vaginal closure force and augmentation of vaginal closure force also did not change with increasing age.

CONCLUSION: In a sample of nulliparous women between 21 and 70 years of age maximal urethral closure pressure in the senescent urethra was 40% of that in the young urethra; increasing age did not affect clinical measures of pelvic organ support, urethral support, and levator function.

LEVEL OF EVIDENCE: III