Pelvic organ prolapse (POP) is characterized by descent of pelvic organs from their normal positions. In women, the condition usually occurs when the pelvic floor collapses after gynecological cancer treatment, childbirth or heavy lifting. In men, it may occur after the prostate gland is removed. The injury occurs to fascia membranes and other connective structures that can result in

cystocele A cystocele, also known as a prolapsed bladder, is a medical condition in which a woman's bladder bulges into her vagina. Some may have no symptoms. Others may have trouble starting urination, urinary incontinence, or frequent urination. Complica ...

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 pel ...

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

Types

* Anterior vaginal wall prolapse **

Cystocele A cystocele, also known as a prolapsed bladder, is a medical condition in which a woman's bladder bulges into her vagina. Some may have no symptoms. Others may have trouble starting urination, urinary incontinence, or frequent urination. Complica ...

(bladder into vagina) **

Urethrocele A urethrocele is the prolapse of the female urethra into the vagina. Weakening of the tissues that hold the urethra in place may cause it to protrude into the vagina. Urethroceles often occur with cystoceles (involving the urinary bladder as well ...

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

Enterocele An enterocele is a protrusion of the small intestines and peritoneum into the vaginal canal. It may be treated transvaginally or by laparoscopy Laparoscopy () is an operation performed in the abdomen or pelvis using small incisions (usually 0 ...

(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 pel ...

(rectum into vagina) **

Sigmoidocele Sigmoidocele (also known as Pouch of Douglas descent) refers to a condition where the sigmoid colon The sigmoid colon (or pelvic colon) is the part of the large intestine that is closest to the rectum and anus. It forms a loop that averages abo ...

* 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'' ...

prolapse (roof of vagina) – after hysterectomy

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

Pelvic Organ Prolapse Quantification System

Management

Vaginal prolapses are treated according to the severity of symptoms.

Non-surgical

With conservative measures, such as changes in diet and fitness, Kegel exercises, 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 ch ...

. With a pessary, a rubber or

silicone rubber Silicone rubber is an elastomer (rubber-like material) 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 ...

device fitted to the patient which is inserted into the vagina and may be retained for up to several months. 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. Pessaries should be offered to women considering surgery as a non-surgical alternative.

Surgery

With surgery (for example native tissue repair, biological graft repair, absorbable and non-absorbable mesh repair, colpopexy, colpocleisis). Surgery is used to treat symptoms such as bowel or urinary problems, pain, or a prolapse sensation. Evidence does not support the use of transvaginal

surgical mesh Surgical mesh is a loosely woven sheet which is used as either a permanent or temporary support for organs and other tissues during surgery. Surgical mesh is created from both inorganic and biological materials and is used in a variety of surg ...

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. Safety and efficacy of many newer meshes is unknown. The use of a transvaginal mesh in treating vaginal prolapses is associated with side effects including pain, infection, and organ perforation. Transvaginal repair seems to be more effective than transanal repair in posterior wall prolapse, but adverse effects cannot be excluded. According to the FDA, serious complications are "not rare." A number of class action lawsuits have been filed and settled against several manufacturers of TVM devices. Compared to native tissue repair, transvaginal permanent mesh probably reduces women's perception of vaginal prolapse sensation and probably reduces the risk of recurrent prolapse and of having repeat surgery for prolapse. On the other hand, transvaginal mesh probably has a greater risk of bladder injury and of needing repeat surgery for stress urinary incontinence or mesh exposure. When operating a pelvic organ prolapse, introducing a mid-urethral sling during or after surgery seems to reduce stress urinary incontinence.

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