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Concept
Pelvic organ prolapse
Summary
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 collapses after gynecological cancer treatment, childbirth or heavy lifting. Injury incurred to fascia membranes and other connective structures can result in cystocele, rectocele or both. Treatment can involve dietary and lifestyle changes, physical therapy, or surgery.
Anterior vaginal wall prolapse
Cystocele (bladder into vagina)
Urethrocele (urethra into vagina)
Cystourethrocele (both bladder and urethra)
Posterior vaginal wall prolapse
Enterocele (small intestine into vagina)
Rectocele (rectum into vagina)
Sigmoidocele
Apical vaginal prolapse
Uterine prolapse (uterus into vagina)
Vaginal vault prolapse (descent of the roof of vagina) – after surgical removal of the uterus hysterectomy
Pelvic organ prolapses are graded either via the Baden–Walker System, Shaw's System, or the Pelvic Organ Prolapse Quantification (POP-Q) 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
Pelvic Organ Prolapse Quantification System
Vaginal prolapses are treated according to the severity of symptoms.
With conservative measures, such as changes in diet and fitness, Kegel exercises, and pelvic floor physical therapy.
With a pessary, a rubber or silicone rubber 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.
Official source
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