Pelvic Organ Prolapse

Bladder, rectum, intestine, uterus, cervix, vaginal apex into vaginal vault (to or beyond vaginal walls)

Risk Factors

  • Multi-parity, pelvic surgery hx, C.T. disorders, DM (neuropathy ➔ ↓ muscle innervation)

  • ↑ ABD pressure (cough with COPD, obesity, pelvic tumors, constipation)

Anterior vaginal wall prolapse

  • Associated with Cystocele (bladder sags into vaginal vault)

  • Pubo-cervical fascia weakness

Posterior vaginal wall prolapse

  • Associated with Rectocele (rectum into vaginal vault)

    • Splinting (need to put pressure on vagina to defecate)

  • or Enterocele (intestine into vaginal vault)

    • Recto-vaginal fascia weakness

Uterine prolapse

  • Uterus descends


  • Vaginal fullness, back/pelvic pain

  • Constipation, incomplete rectal emptying

  • ↓ sphincter tone

DX: Pelvic Organ Prolapse Quantitation (POP-Q)

  • Stage 1: Most distal portion of prolapse > 1cm above hymen

  • Stage 2: Almost out

    • 1cm above to 1cm below hymen

  • Stage 3: Some but not all is hanging out

    • Most distal portion of prolapse >1cm outside the hymenal plane, but it is 2 cm less than the maximum possible protrusion

      • (No uterine procidentia/complete vaginal vault eversion... at least some portion is not everted)

  • Stage 4: completely everted (procidentia)


  • Vaginal pessary (not long-term tx)

  • Can tx and prevent with pelvic floor conditioning (Kegels)

  • Surgery if conservative tx fails

    • Cystocele, rectocele, and vaginal wall defects with colporrhaphy

    • Uterine prolapse: Hysterectomy and uterosacral or sacrospinous ligament suspension