Does bladder neck descent increase with age?

It is assumed that pelvic organ descent and prolapse increase with age. Epidemiological studies support this assumption. We aimed to define the relationship between age and bladder neck descent (BND) in a retrospective observational study on 790 women referred for evaluation of pelvic floor disorders. Bladder neck descent, cystocele descent and urethral rotation were evaluated on maximal Valsalva manoeuvre, using trans-labial ultrasound. There was a weak negative correlation between bladder neck descent on Valsalva and age (r = -0.154, p < 0.001), which was absent in nulliparous women (n = 107) and stronger (r = -0.213, p < 0.001) in parous women (n = 683). This relationship was evident from the age of 50 years onwards and may be explained by increased tissue stiffness after menopause. The difference observed between parous and nulliparous women is intriguing and raises the issue of obstetric confounders such as historical changes in the likelihood of significant pelvic floor trauma.