Title : Understanding pelvic organ prolapse
Abstract:
Pelvic Organ Prolapse (POP) is descent of one or more pelvic structures, from the normal anatomic position, usually to or beyond the hymenal remnants, owing to loss of support from the connective tissue, muscles, or both. It can lead to symptoms of pelvic pressure, vaginal bulge, urinary and bowel dysfunction, and sexual dysfunction in elderly patients. Prevalence of symptomatic POP is estimated to range from 2.9 to 50%. Prevalence of asymptomatic POP is probably even higher. In the United States, it is estimated the annual number of women undergoing surgeries for POP will reach >190,000 by 2020. Surgery for POP is performed twice as commonly as continence surgery.
Exact etiologies of POP is unknown: however it is likely multifactorial that can cause collagen weakness. The risk factors for primary POP are vaginal delivery, parity, birthweight, older age, body mass index, levator defect, and a larger levator hiatal area. The risk factors for POP recurrence are younger age and preoperative prolapse stage 3 or 4. Assessment of POP symptoms should be included in annual well women’s health visits.
Common symptoms of POP include, but not limited to sensation of vaginal bulge, pressure and discomfort, dyspareunia, decreased libido and orgasm, increased embarrassment with altered anatomy affecting body image, associated symptoms relating to voiding, defecatory and sexual function.
POP is diagnosed during pelvic examination. Taking through medical history is important to elicit POP associated symptoms. The Pelvic Organ Prolapse Quantitation (POPQ) system, introduced in 1996, has become the standard classification system.
Treatment is generally not indicated for asymptomatic POP. Treatment is indicated for women with symptoms of POP or associated conditions like bowel, urinary or sexual dysfunction. Obstructed urination or defecation or hydronephrosis from chronic ureteral kinking are indications for treatment, regardless of degree of POP. Treatment is individualized according to the patient’s symptoms and their impact on her quality of life.
General practitioners should be able to evaluate the patient with POP and offer conservative management in office: If conservative management fails, patients should be referred to Urogyn for further management. Surgical management is offered to women with symptomatic POP, who have failed or declined conservative management.
