Pelvic organ prolapse:
- Pelvic organ prolapse (POP) is 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).
- Presence of any pelvic organ prolapse sign should be correlated with relevant POP symptoms.
- Risk factors include increasing age, parity and family history along with obesity, heavy lifting and constipation.
- A common problem, occurring in up to 40% of women older than 50 years, which may impact on daily activity and quality of life.
Main presenting features:
- Symptoms vary depending on the site and severity of the prolapse. The symptoms are likely to vary over the course of the day and over a period of time, including through the monthly cycle in pre-menopausal women.
- A patient with prolapse might present with vaginal, bladder, bowel, back, abdominal and sexual symptoms, including feeling of ‘something coming down’, pelvic pressure (heaviness, dragging), incomplete bladder or bowel emptying (possibly with the need to support the vaginal wall to aid emptying), low back ache, pain or difficulty during sexual intercourse and vaginal bleeding, discharge or infection.
- Pelvic organ prolapse may be so severe that there is protrusion of the vaginal wall and/or cervix/vaginal vault below the vaginal introitus.
- Symptoms are likely to be increased by gravity (e.g. standing for prolonged periods) and abdominal straining (e.g. after a period of heavy work/lifting).