Pelvic organ prolapse is the abnormal descent or herniation of the pelvic organs from their normal attachment sites or their normal position in the pelvis. The pelvic structures that may be involved include the uterus (uterine prolapse) or vaginal apex (apical vaginal prolapse), anterior vagina (cystocele), or posterior vagina (rectocele). Many parous women may have some degree of prolapse when examined; however, most prolapses are not clinically bothersome without specific pelvic symptoms, and they may not require an intervention.
Pelvic organ prolapse (POP) mortality is rare due to this health issue, it has been shown that self-perception of the body is significantly affected in those with symptoms. Data from 1997 shows close to 350,000 pelvic organ prolapse operations performed in the United States alone.Furthermore, it is expected that 11% of women over the age of 80 will undergo surgery for such conditions, with an additional 30% who will require a repeat surgery. The direct cost based on this data is estimated to be over one billion dollars.The prevalence of urinary incontinence is thought to vary from 17-45% among adult women. Likewise, 50% of parous women have pelvic organ prolapse. The distribution of the severity of this condition among the general population has been studied since the development of a standardized evaluation method known as the pelvic organ prolapse quantification system (POP-Q). An initial study showed a bell-shaped curve distribution with the majority of women having Stage 1 or 2 prolapse in a population of 497 women greater than or equal to 18 years of age with a mean age of 44 years. These stages were defined as the distal end of the prolapse being >1 cm and ≤ 1cm of the hymen during abdominal straining, respectively. A more progressive prolapse was noted in women greater than 40 years of age with 21% being in the age group of greater than the age of 70, suggesting that age plays a role.
If you do not have any symptoms or if your symptoms are mild, you do not need any special follow-up or treatment beyond having regular checkups. If you have symptoms, prolapse may be treated with or without surgery. Often the first nonsurgical option tried is a pessary. This device is inserted into the vagina to support the pelvic organs. Targeting specific symptoms may be another option. Kegel exercises may be recommended in addition to symptom-related treatment to help strengthen the pelvic floor. Weight loss can decrease pressure in the abdomen and help improve overall health. If your symptoms are severe and disrupt your life, and if nonsurgical treatment options have not helped, you may want to consider surgery.
Each year, 225,000 women in the Australia undergo surgery for pelvic organ prolapse, but little is known about long-term surgical outcomes,” and pelvic reconstructive surgeon at the University and first author on the study. “As our population ages, more and more women are going to be affected by pelvic organ prolapse, so it’s critical to know whether these surgeries are effective.”