Tags

Type your tag names separated by a space and hit enter

Uterine and Pelvic Organ Prolapse

Uterine and Pelvic Organ Prolapse is a topic covered in the 5-Minute Clinical Consult.

To view the entire topic, please or purchase a subscription.

Medicine Central™ is a quick-consult mobile and web resource that includes diagnosis, treatment, medications, and follow-up information on over 700 diseases and disorders, providing fast answers—anytime, anywhere. Explore these free sample topics:

Medicine Central

-- The first section of this topic is shown below --

Basics

Description

  • 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
    • Heaviness
    • Bulging
    • Bowel or bladder symptoms
  • Cost associated with treatment is >$1 billion annually (~200,000 surgeries per year) (2).

Epidemiology

Incidence
  • 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).

Prevalence
  • 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

Risk Factors

  • Vaginal childbirth: Each additional vaginal birth increases risk (2,4).
  • Age
  • 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)

General Prevention

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

  • Constipation
  • Fecal incontinence
  • Urinary incontinence or retention
  • Other urinary symptoms
    • Urgency
    • Frequency

-- To view the remaining sections of this topic, please or purchase a subscription --

Citation

Stephens, Mark B., et al., editors. "Uterine and Pelvic Organ Prolapse." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816537/0.5/Uterine_and_Pelvic_Organ_Prolapse.
Uterine and Pelvic Organ Prolapse. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816537/0.5/Uterine_and_Pelvic_Organ_Prolapse. Accessed July 15, 2019.
Uterine and Pelvic Organ Prolapse. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816537/0.5/Uterine_and_Pelvic_Organ_Prolapse
Uterine and Pelvic Organ Prolapse [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 July 15]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816537/0.5/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 - 816537 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816537/0.5/Uterine_and_Pelvic_Organ_Prolapse PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -