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Abstract
Pelvic organ prolapse (POP) is defined, according to the International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction 2010, as: The descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus (cervix), or the apex of the vagina (vaginal vault or cuff scar after hysterectomy). The presence of any such sign should be correlated with relevant POP symptoms. More commonly, this correlation would occur at the level of the hymen or beyond.
The support of pelvic viscera is mainly through the pelvic connective tissue fascia and pelvic floor muscles. The connective tissue supporting the pelvic viscera includes the endopelvic fascia, the arcus tendineus fascia pelvis and the utersacral and the cardinal ligaments. In addition the vagina has structural integrity provided by the pubocervical fascia anteriorly and rectovaginal fascia posteriorly. The muscular support is provided by the levator ani muscle with its intact nerve supply.
The risk factors associated with prolapse include white race, familial hereditary connective tissue diseases, vaginal delivery, obesity, old age and menopausal deprivation of sex steroids.
In general, women with vaginal prolapse often do not complain of any symptoms until the problem has progressed to stage 3. At that time, the common complaint is of a vaginal protrusion or bulge that the patient first noticed while bathing. Early symptoms also include dyspareunea, feelings of pelvic pressure or fullness, and pain with prolonged standing. As the prolapse progresses, a woman may develop urinary or fecal frequency or urgency, symptoms of urinary or fecal obstruction with incomplete voiding and straining, or the need to digitally reduce (splint) the prolapse in order to defecate or urinate. The Pelvic Organ Prolapse Quantification (POP-Q) score is a descriptive system that allows a precise report of an individual woman’s support to the anterior, posterior, and apical aspects of the vagina by measuring the distance between the defined points on those aspects and a fixed point of reference, hymenal ring. It provides a standardized means for documenting, comparing, and communicating clinical findings with proven inter-observer and intra-observer reliability.
Pelvic organ prolapse has a great effect on the Quality of life (QoL). Quality of life is measured by the questionnaires completed by the patients or their carers. Those questionnaires should be included in the initial assessment of the patients and after any medical and surgical interventions and during the follow up visits.
Conservative management of POP includes the use of vaginal pessaries preferred with the use of local estrogen cream in postmenopausal women to reduce the risk of vaginal erosions. On the other hand, a recent Cochrane Database Systemic Review determined that there is no evidence from randomized controlled trials to support the use of pelvic floor muscle training in management of pelvic organ prolapsed .