Uterine and Pelvic Organ Prolapse
- Symptomatic descent of one or more of (1),(2)
- The anterior vaginal wall (bladder or cystocele)
- The posterior vaginal wall (rectum or rectocele)
- The uterus and cervix
- The vaginal apex (vault or cuff scar after hysterectomy)
- Prolapses above or to the level of the hymen are generally not symptomatic (2).
- Associated symptoms (2)
- Feeling of vaginal or pelvic pressure
- Bowel or bladder symptoms
- Cost associated with treatment is >$1 billion annually (~200,000 surgeries per year) (2).
- The incidence of pelvic organ prolapse (POP) ranges from 1.5 to 1.8 per 1,000 woman-years and peaks in women aged 60 to 69 years (3).
- In the United States, there are approximately 300,000 surgeries for POP each year (3), and a woman’s lifetime risk of undergoing surgery for pelvic floor prolapse ranges from 6% to 18% (3).
- A national survey of 7,924 women (>20 years of age) found a prevalence of 25% for one or more pelvic floor disorders (including urinary incontinence, fecal incontinence, and POP). Prevalence of POP was 3–6% (4).
- POP is common but not always symptomatic. It does not always progress. It is estimated that 50% of women will develop prolapse, but only 10–20% of those will seek care for their condition (3).
Etiology and Pathophysiology
- Pelvic organs are supported by attachments between pelvic floor muscles, connective tissue, and the bony pelvis. Defects in this support can lead to prolapse in one or multiple compartments (5).
- Symptomatic women typically have defects in more than one compartment as well as damage to the levator ani and its attachments to the pelvis (5).
- Gradual process that begins long before symptoms develop
- Vaginal childbirth: Each additional vaginal birth increases risk (2),(4).
- Family history (2)
- Race: White and Hispanic women may be at higher risk than black or Asian women (1),(2).
- Obesity BMI >30 kg/m2 (2),(4)
- Chronic straining (constipation, chronic cough from pulmonary disease, repeated heavy lifting) (2)
- History of hysterectomy (2),(4)
There is some evidence that pelvic floor muscle training (“Kegel exercises”) may decrease the risk of symptomatic POP (5)[B]. Weight loss and proper management of conditions that cause increase in intra-abdominal pressure such as constipation may help prevent prolapse (5)[C]. Elective caesarean delivery has not been shown to prevent prolapse.
Commonly Associated Conditions
- Fecal incontinence
- Urinary incontinence or retention
- Other urinary symptoms
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Domino, Frank J., et al., editors. "Uterine and Pelvic Organ Prolapse." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688802/all/Uterine_and_Pelvic_Organ_Prolapse.
Uterine and Pelvic Organ Prolapse. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688802/all/Uterine_and_Pelvic_Organ_Prolapse. Accessed June 4, 2023.
Uterine and Pelvic Organ Prolapse. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688802/all/Uterine_and_Pelvic_Organ_Prolapse
Uterine and Pelvic Organ Prolapse [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 June 04]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688802/all/Uterine_and_Pelvic_Organ_Prolapse.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Uterine and Pelvic Organ Prolapse ID - 1688802 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688802/all/Uterine_and_Pelvic_Organ_Prolapse PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -