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 :

1. Age

Women of every age may be affected, even though pelvic organ prolapse is more common in older women.

2. Injury

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

4. Pelvic surgery

5. Miscellaneous

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

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).

Non-surgical treatment

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.

Pessaries

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

Surgical management

Native tissue repairs

Vaginal mesh for anterior and posterior vaginal wall prolapse

Uterine preservation

Concomitant stress continence surgery