Pelvic organ prolapse

Background

Pelvic organ prolapse

• Herniation of pelvic organs to or beyond vaginal walls

Risk Factors

• Advancing Age
• Multiparity
• Obesity
• Race: Latina + Caucasian Women higher risk than African American Women
• Constipation
• Connective Tissue Disorders
• Chronic Cough

Clinical Features

Severity may be related to position

• • Less noticeable in AM and supine
  • Worse as day progresses, upright, and active
    

Vaginal Bulge/Fullness

Vaginal Pressure

Urinary Dysfunction

• • Overactive bladder symptoms
  • Urgency
  • Urinary incontinence
  • Enuresis
    

Defecatory Dysfunction

• • Constipation
  • Incomplete emptying
  • Fecal urgency
  • Fecal incontinence
  • Obstructive symptoms- Straining or need for digital pressure to vagina in order to completely evacuate
    

Sexual Dysfunction

• • Reports of adverse effects or orgasm and sexual satisfaction
  • Dyspareunia
  • Avoidace of sexual activity due to fear of discomfort or embarassment

Differential Diagnosis

Cystocele

• Most common form of pelvic organ prolapse
• Hernia of anterior vaginal wall + descent of bladder

Rectocele

• Hernia of posterior vaginal segment + descent of rectum

Enterocele

• Hernia of intestines to or through vaginal wall

Uterine/Vaginal Vault Prolapse

• Descent of apex of vagina to lower vagina, hymen, or beyond introitus
• Apex= uterus and cervix, cervix, or vaginal vault
• Apical prolapse often associated with enterocele

Evaluation

Clinical Diagnosis

Management

Emergency Room

Look for signs of infection or skin breakdown if prolonged prolapse

Reduction may be as simple as pushing organ back inside

If difficult reduction due to edema

• Provide analgesia, and place copious granulated sugar
• Wait 15 minutes for edema to subside and re-attempt reduction
• If reduction fails, consult Gynecology

Outpatient

Treatment includes:

• Expectant management
• Conservative (vaginal pessary, pelvic floor muscle exercises)
• Surgical
  

Disposition

Discharge with outpatient Gynecology referral

See Also

Rectal Prolapse

References

Rogers, RG, Fashokun, TB. Pelvic organ prolapse in women: Epidemiology, risk factors, clinical manifestations, and management. In: Post T, ed. UpToDate; Waltham, MA.: UpToDate; 2020. www.uptodate.com. Accessed June 16, 2020