Pelvic organ prolapse (POP) is characterized by descent of pelvic organs from their normal positions into the vagina. In women, the condition usually occurs when the

pelvic floor The pelvic floor or pelvic diaphragm is an anatomical location in the human body which has an important role in urinary and anal continence, sexual function, and support of the pelvic organs. The pelvic floor includes muscles, both skeletal and ...

collapses after gynecological cancer treatment, childbirth or heavy lifting. Injury incurred to fascia membranes and other connective structures can result in cystocele,

rectocele In gynecology, a rectocele ( ) or posterior vaginal wall prolapse results when the rectum bulges ( herniates) into the vagina. Two common causes of this defect are childbirth and hysterectomy. Rectocele also tends to occur with other forms of ...

or both. Treatment can involve dietary and lifestyle changes, physical therapy, or surgery.

Types

* Anterior vaginal wall prolapse ** Cystocele (bladder into vagina) ** Urethrocele (urethra into vagina) ** Cystourethrocele (both bladder and urethra) * Posterior vaginal wall prolapse **

Enterocele An enterocele is a herniation of a peritoneum-lined sac containing small intestine through the pelvic floor, between the rectum and the vagina (in females). Enterocele is significantly more common in females, especially after hysterectomy. It has ...

(small intestine into vagina) **

Rectocele In gynecology, a rectocele ( ) or posterior vaginal wall prolapse results when the rectum bulges ( herniates) into the vagina. Two common causes of this defect are childbirth and hysterectomy. Rectocele also tends to occur with other forms of ...

(rectum into vagina) ** Sigmoidocele * Apical vaginal prolapse ** Uterine prolapse (uterus into vagina) **

Vaginal vault The vaginal vault is the expanded region of the vaginal canal at the internal end of the vagina. Prolapse The vaginal vault may prolapse after a hysterectomy, as there is no uterus supporting the interior end of the vagina. ''Colposacropexy'' i ...

prolapse (descent of the roof of vagina) – after surgical removal of the uterus

hysterectomy Hysterectomy is the surgical removal of the uterus and cervix. Supracervical hysterectomy refers to removal of the uterus while the cervix is spared. These procedures may also involve removal of the ovaries (oophorectomy), fallopian tubes ( salpi ...

Grading

Pelvic organ prolapses are graded either via the Baden–Walker System, Shaw's System, or the Pelvic Organ Prolapse Quantification (POP-Q) System.

Shaw's System

Anterior wall * Upper 2/3 cystocele * Lower 1/3 urethrocele Posterior wall * Upper 1/3 enterocele * Middle 1/3 rectocele * Lower 1/3 deficient perineum Uterine prolapse * Grade 0 Normal position * Grade 1 descent into vagina not reaching introitus * Grade 2 descent up to the introitus * Grade 3 descent outside the introitus * Grade 4 Procidentia

Baden–Walker

POP-Q

Management

Vaginal prolapses are treated according to the severity of symptoms.

Non-surgical

With conservative measures, such as changes in diet and fitness,

Kegel exercise Kegel exercise, also known as pelvic floor exercise, involves repeatedly contracting and relaxing the muscles that form part of the pelvic floor, now sometimes colloquially referred to as the "Kegel muscles". The exercise can be performed many ti ...

s, and

pelvic floor physical therapy Pelvic floor physical therapy (PFPT) is a specialty area within physical therapy focusing on the rehabilitation of muscles in the pelvic floor after injury or dysfunction. It can be used to address issues such as muscle weakness or tightness post c ...

. A

pessary A pessary is a prosthetic device inserted into the Human vagina, vagina for structural and pharmaceutical purposes. It is most commonly used to treat Stress incontinence, stress urinary incontinence to stop urinary leakage and to treat pelvic org ...

, a rubber or

silicone rubber Silicone rubber is an elastomer composed of silicone—itself a polymer—containing silicon together with carbon, hydrogen, and oxygen. Silicone rubbers are widely used in industry, and there are multiple formulations. Silicone rubbers ar ...

device fitted to the patient is also a non-surgical option, it is inserted into the vagina and may be retained for up to several months. Vaginal pessaries can immediately relieve prolapse and prolapse-related symptoms. Pessaries are a good choice of treatment for women who wish to maintain fertility, are poor surgical candidates, or who may not be able to attend physical therapy. Pessaries require a provider to fit the device, but most can be removed, cleaned, and replaced by the woman herself; however, others have this done for them by a clinician biannually. A trial compared the two approaches and found that, compared with clinic-based care, self-management was associated with a similar quality of life, fewer complications, and was more cost-effective. Pessaries should be offered as a non-surgical alternative for women considering surgery.

Surgery

Surgery Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

(for example native tissue repair, biological graft repair, absorbable and non-absorbable mesh repair, colpopexy, or colpocleisis) is used to treat symptoms such as bowel or urinary problems, pain, or a prolapse sensation. When operating a pelvic organ prolapse, introducing a mid-urethral sling during or after surgery seems to reduce stress urinary incontinence. Transvaginal repair seems to be more effective than transanal repair in posterior wall prolapse, but adverse effects cannot be excluded. According to the

FDA The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food ...

, serious complications are "not rare." Evidence does not support the use of transvaginal surgical mesh compared with native tissue repair for anterior compartment prolapse owing to increased morbidity. For posterior vaginal repair, the use of mesh or graft material does not seem to provide any benefits. Compared to native tissue repair, transvaginal permanent mesh likely reduces the perception of vaginal prolapse sensation, the risk of recurrent prolapse, and of having repeat surgery specifically only for prolapse. Transvaginal mesh (TVM) has a greater risk of bladder injury and of needing repeat surgery for stress urinary incontinence or mesh exposure. The use of a TVM in treating vaginal prolapses is associated with severe side effects including

organ perforation Organ perforation is a complete penetration of the wall of a hollow organ in the body, such as the gastrointestinal tract in the case of gastrointestinal perforation. It mainly refers to accidental or pathologic perforation, rather than intention ...

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

, and

pain Pain is a distressing feeling often caused by intense or damaging Stimulus (physiology), stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sense, sensory and emotional experience associated with, or res ...

. Safety and efficacy of many newer meshes is unknown. Thousands of

class action lawsuits A class action is a form of lawsuit. Class Action may also refer to: * ''Class Action'' (film), 1991, starring Gene Hackman and Mary Elizabeth Mastrantonio *Class Action (band), a garage house band * "Class Action" (''Teenage Robot''), a 2002 epi ...

have been filed and settled against several manufacturers of TVM devices. For surgical treatment of apical vaginal prolapse, going through the abdomen (sacral colpopexy) may have better outcomes than a surgical approach that goes through the vagina.

Epidemiology

Genital prolapse occurs in about 316 million women worldwide as of 2010 (9.3% of all females).

Research

To study POP, various animal models are employed: non-human primates, sheep, pigs, rats, and others.

References

External links

{{Diseases of the pelvis, genitals and breasts Noninflammatory disorders of female genital tract Vagina