Overview Pelvic organ prolapse is a condition in which pelvic organs abnormally descend or herniate from their normal attachment sites or their normal position in the pelvis to or beyond the vaginal walls. There are varying degrees of prolapse. In the most severe cases, the pelvic organ can prolapse through the genital hiatus. It can be asymptomatic or symptomatic. Very prevalent (~15% of older age women).
Definition Pelvic organ prolapse: This is a condition in which pelvic organs abnormally descend or herniate from their normal attachment sites or their normal position in the pelvis to or beyond the vaginal walls. There are varying degrees of prolapse. In the most severe cases, the pelvic organ can prolapse through the genital hiatus |
Anatomy - Genital Support (De Lancey - 3 level of support)
Organs that support
Bulge or vaginal pressure symptoms This symptom is associated with a prolapse however it does not indicate the stage of prolapse. Anatomically this is defined as a prolapse beyond the hymen
Urinary symptoms Loss of support of the anterior vaginal wall or the vaginal apex can affect the bladder and/or urethral function.
Defecatory symptoms Affects between 24-52% of women with POP
Sexual function Not associated with decreased sexual desire or with dyspareunia
Examination
TYPES OF PROLAPSE | |
Condition | Feature |
Uterine prolapse | |
Cystocele | |
Rectocele | |
Enterocele | |
Vaginal vault prolapse | |
Uterine procidentia |
Different types of Pelvic organ prolapse
Grades of uterine prolapse
Not really needed unless rectal, uterine pathology suspected
Prevention of prolapse
Remember The goal of conservative management is to improve symptoms, reduce progression, and avoid or delay surgical treatment |
Asymptomatic
Symptomatic
Surgery
Surgery Indication | Surgery Contraindication |
Treatment depends on symptoms, level of medical fitness, | Asymptomatic women even with an objective prolapse |
Desire for fertility | Success of surgery is going to be limited by issues such as: Chronic cough, Smoking, Previous surgery, Connective tissue disorders, excessive weight |
Complications of prolapse
Complications of surgery