Pelvic Organ Prolapse

Excerpt

Pelvic organ prolapse is the descent of pelvic structures into the vagina due to ligament or muscular weakness. Pelvic organ prolapse (POP) is subcategorized according to the compartment of descent. Cystocele characterizes anterior wall herniation, rectocele refers to the posterior vaginal wall descent, and vaginal vault prolapse characterizes the descent of the uterus, cervix, or apex of the vagina. They can occur either singly or in combination. Although the etiology of POP is multifactorial, there is a high correlation between pregnancy and vaginal delivery, which can lead to direct pelvic floor muscle and connective tissue injury.

Additionally, prior pelvic surgeries or conditions associated with sustained episodes of increased intrabdominal pressure, such as heavy lifting, obesity, chronic cough, and constipation, can increase the risk of developing POP. Most patients who present with prolapse are asymptomatic. However, symptoms become more bothersome as the bulge protrudes past the vaginal opening. Initial evaluation includes a detailed history and a systematic pelvic exam. An assessment of POP complications, including urinary incontinence, bladder outlet obstruction, and fecal incontinence, must be made.

Treatment options vary and are dependent upon the degree of prolapse and symptoms. Treatments include simple observation, vaginal pessaries, or surgical management. Available surgical options are reconstructive pelvic surgery with or without mesh augmentation and obliterative surgery.