Pelvic Organ Prolapse

Pathophysiology

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.

Disease statistics

Pelvic organ prolapse (POP) is the dropping of the pelvic organs caused by weakness or damage to the normal support of the pelvic floor. Prevalence of a disease state (stage II prolapse or greater) varies by data source from 3% of parous womento 19% of women with advanced disease requiring surgery. As many as 50% of women may have some degree of POP. Clinical manifestations related to POP often become evident after menopause though it is becoming a serious health problem for women of all ages with first symptoms that might be experienced before age 30. POP rarely occurs as a separate condition and often correlates with urinary and faecal incontinence, sexual dysfunction, psychological, and social disadaptation .Risk factors, which predispose to POP, include pelvic floor injury (vaginal parity and pelvic floor trauma during childbirth), lifestyle and health conditions (mainly, menopause, body mass index (BMI), chronic cough, constipation, and heavy lifting), genetic-related conditions (ethnicity, connective tissue disorders, and familial character of prolapse. Forty-three percent of the variation in susceptibility for POP may be explained by genetic effects.

Treatment

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

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.