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

SSX

• 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)

TX

• 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