Pelvic Organ Prolapse
Pelvic organ prolapse is descent of the bladder, uterus, rectum or vaginal vault into or through the vagina because the pelvic floor muscles and fascia that support them have weakened; it is common after childbirth and around the menopause, and management runs from pelvic floor training and pessaries to surgery.
Definition
Pelvic organ prolapse is the descent of one or more of the pelvic organs (bladder, uterus, rectum, or vaginal vault after hysterectomy) into or through the vagina, resulting from weakness of the pelvic floor muscles and connective tissue supports. It is described by the affected compartment (anterior, posterior or apical) and staged by the degree of descent.
First principles
Why the pelvic floor holds the organs up
The pelvic organs are supported by levator ani muscle and connective-tissue supports including the endopelvic fascia and uterosacral/cardinal ligaments. Prolapse occurs when this support is stretched, injured or weakened, allowing a vaginal wall, uterus or vault to descend. Symptoms and treatment depend on the compartment and the woman's symptom burden, not POP-Q stage alone.
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