Abstract

Pelvic organ prolapse (POP) is characterized by descent of pelvic organs from their normal positions. In women, the condition usually occurs when the pelvic floor collapses after gynecological cancer treatment, childbirth or heavy lifting.

In men, it may occur after the prostrate gland is removed. The injury occurs to fascia membranes and other connective structures that can result in cystocele, rectocele or both. Treatment can involve dietary and lifestyle changes, physical therapy, or surgery.

Grading

Pelvic organ prolapses are graded either via the Baden-Walker System, Shaw's System, or the Pelvic Organ Prolapse Quantification (POP-Q) System.

Grading | Shaw's System

Anterior wall

- Upper 2/3 cystocele

- Lower 1/3 urethrocele

Posterior wall

- Upper 1/3 enterocele

- Middle 1/3 rectocele

- Lower 1/3 deficient perenium

Uterine prolapse

- Grade 0 Normal position

- Grade 1 descent into vagina not reaching introitus

- Grade 2 descent up to the introitus

- Grade 3 descent outside the introitus

- Grade 4 Procidentia

Management

Vaginal prolapses are treated according to the severity of symptoms. They can be treated:

- With conservative measures (changes in diet and fitness, Kegel exercises, pelvic floor physical therapy.

- With a pessary, a rubber or silicon device fitted to the patient which is inserted into the vagina and may be retained for up to several months. Pessaries are a good choice of treatment for women who wish to maintain fertility, are poor surgical candidates, or who may not be able to attend physical therapy. Pessaries require a provider to fit the device, but most can be removed, cleaned, and replaced by the woman herself. Pessaries should be offered to women considering surgery as a non-surgical alternative.

- With surgery (for example native tissue repair, biological graft repair, absorbable and non-absorbable mesh repair, colpopexy, colpocleisis). Surgery is used to treat symptoms such as bowel or urinary problems, pain, or a prolapse sensation. According to the Cochrane Collaboration review (2016) current evidence does not support the use of transvaginal surgical mesh repair compared with native tissue repair for anterior compartment prolapse owing to increased morbidity. Safety and efficacy of many newer meshes is unknown. The use of a transvaginal mesh in treating vaginal prolapses is associated with side effects including pain, infection, and organ perforation. According to the FDA, serious complications are "not rare." A number of class action lawsuits have been filed and settled against several manufacturers of TVM devices.

Epidemiology

Genital prolapse occurs in about 316 million women worldwide as of 2010 (9.3% of all females).