Pelvic organ prolapse
Pelvic organ prolapse, or genital prolapse, is the descent of one or more of the pelvic structures (bladder, uterus, vagina) from the normal anatomic location toward or through the vaginal opening.
Risk factors :
Women of every age may be affected, even though pelvic organ prolapse is more common in older women.
Direct injury to the levator ani, as well as neurologic injury from stretching of the pudendal nerves that may occur with vaginal childbirth, is also some cause for the occurrence of pelvic organ prolapse
3. Lifestyle factors
- Smoking: Chronic Obstructive Pulmonary Disease
- High-impact exercise
- Physically strenuous (manual) occupation
4. Pelvic surgery
- Pelvic organ prolapse surgery
Ethnicity and an increase in intra-abdominal pressure from chronic coughing, straining with constipation, or repeated heavy lifting may contribute to pelvic organ prolapse
Management of pelvic organ prolapse
Management options for women with symptomatic prolapse include
- Pelvic floor muscle training
- Mechanical support (pessaries)
Pessary use should be considered prior to surgery in women who have symptoms indicative of prolapse. The majority of women can be fitted with a pessary regardless of the stage or site of predominant prolapse. Surgical procedures are obliterative (eg sacral colpopexy) or reconstructive (eg colpocleisis).
Conservative interventions include physical interventions to improve the function and support of the pelvic floor muscles (via pelvic floor muscle training) and mechanical interventions (insertion of vaginal pessaries) to support the prolapse. They are frequently offered for lower grades of prolapse and to women unwilling or unfit to undergo surgery.
From prehistoric times, an extensive variety of items have been used to manage urogenital prolapse. Presently, a range of vaginal pessaries is available which can be broadly divided into two types: support and space-occupying. When the insertion of the pessary is successful, there is considerable improvement in prolapse symptoms, and in the bladder, bowel and sexual function.
Pelvic floor muscle training (PFMT)
A vigorous evidence base has lately emerged regarding the role of PFMT in the treatment of pelvic organ prolapse. The permutation of PFMT with surgery or insertion of vaginal pessary has lately gained the attention. Perioperative PFMT has shown benefit in the post-surgery reduction of symptoms and pelvic organ prolapse recurrence
- Native tissue repairs
- Vaginal mesh for anterior and posterior vaginal wall prolapse
- Uterine preservation
- Concomitant stress continence surgery