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.
The weighted prevalence rate of one or more pelvic floor disorder was 25.0% (95% CI 23.6, 26.3), including 17.1% (95% CI 15.8, 18.4) of women with moderate-to-severe urinary incontinence, 9.4% (95% CI 8.6, 10.2) with fecal incontinence, and 2.9% (95% CI 2.5, 3.4) with prolapse. From 2005 to 2010, no significant differences were found in the prevalence rates of any individual disorder or for all disorders combined (p>0.05). After adjusting for potential confounders, higher BMI, greater parity, and hysterectomy were associated with higher odds of one or more pelvic floor disorder.
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.
Research conducted by the Pelvic Floor Disorders Network, an initiative funded by the National Institutes of Health, has revealed that the long-term success rates of a surgery to treat pelvic organ prolapse are lower than expected. Nearly one-third of women develop anatomic or symptomatic treatment failure within five years of undergoing sacrocolpopexy for pelvic organ prolapse.