Uterine and Pelvic Organ Prolapse
- Symptomatic descent of one or more of the following (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)
- Prolapse above or to the level of the hymen are generally not symptomatic.
- Associated symptoms
- Feeling of pelvic pressure or heaviness
- Vaginal bulge
- Bowel or bladder symptoms
- Cost associated with treatment is >$1 billion annually (~200,000 surgeries per year).
- 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.
- In the United States, there are approximately 300,000 surgeries for POP each year, and a woman’s lifetime risk of undergoing surgery for pelvic floor prolapse ranges from 6% to 18%.
- When POP is defined by the patient’s symptoms alone, the prevalence is 2.9–8%. When defined by exam findings, the prevalence is 41.1%.
- 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.
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 (3).
- Symptomatic women typically have defects in more than one compartment as well as damage to the levator ani muscle complex (a critical component of uterovaginal support) and its attachments to the pelvis (3).
- Gradual process that often begins long before symptoms develop
- Vaginal childbirth: Each additional vaginal birth increases risk (1).
- Increasing age
- Family history
- Race: White and Hispanic women may be at higher risk than black or Asian women (2).
- Obesity BMI >30 kg/m2
- Chronic straining (constipation, chronic cough from pulmonary disease, repeated heavy lifting)
- History of hysterectomy
Commonly Associated Conditions
- Fecal incontinence
- Urinary incontinence or retention
- Other urinary symptoms
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