Pelvic organ prolapse

  • Jelovsek J
  • Maher C
  • Barber M
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Abstract

Pelvic organ prolapse is downward descent of female pelvic organs, including the bladder, uterus or post-hysterectomy vaginal cuff , and the small or large bowel, resulting in protrusion of the vagina, uterus, or both. Prolapse development is multifactorial, with vaginal child birth, advancing age, and increasing body-mass index as the most consistent risk factors. Vaginal delivery, hysterectomy, chronic straining, normal ageing, and abnormalities of connective tissue or connective-tissue repair predispose some women to disruption, stretching, or dysfunction of the levator ani complex, connective-tissue attachments of the vagina, or both, resulting in prolapse. Patients generally present with several complaints, including bladder, bowel, and pelvic symptoms; however, with the exception of vaginal bulging, none is specifi c to prolapse. Women with symptoms suggestive of prolapse should undergo a pelvic examination and medical history check. Radiographic assessment is usually unnecessary. Many women with pelvic organ prolapse are asymptomatic and do not need treatment. When prolapse is symptomatic, options include observation, pessary use, and surgery. Surgical strategies for prolapse can be categorised broadly by reconstructive and obliterative techniques. Reconstructive procedures can be done by either an abdominal or vaginal approach. Although no eff ective prevention strategy for prolapse has been identifi ed, considerations include weight loss, reduction of heavy lifting, treatment of constipation, modifi cation or reduction of obstetric risk factors, and pelvic-fl oor physical therapy. Pelvic organ prolapse, also called urogenital prolapse, is downward descent of the pelvic organs that results in a protrusion of the vagina, uterus, or both. 1 It is a disorder exclusive to women and can aff ect the anterior vaginal wall, posterior vaginal wall, and uterus or apex of the vagina, usually in some combination. 2 Pelvic organ prolapse is distinct from rectal prolapse, in which the rectum protrudes through the anus, aff ecting both men and women. In 1997, more than 225 000 inpatient surgical procedures for pelvic organ prolapse were undertaken in the USA (22·7 per 10 000 women), at an estimated cost of more than US$1 billion. 3,4 In the UK, the disorder accounts for 20% of women on the waiting list for major gynaecological surgery. 5 Pelvic organ prolapse is the leading indication for hysterectomy in postmenopausal women and accounts for 15–18% of procedures in all age-groups. 6 It rarely results in severe morbidity or mortality; rather, it causes symptoms of the lower genital, urinary, and gastrointestinal tracts that can aff ect a woman's daily activities and quality of life. 7

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Authors

  • J Eric Jelovsek

  • Christopher Maher

  • Matthew D Barber

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