Pelvic Organ Prolapse (POP)
POP is the descent of one or more pelvic organs (bladder, uterus, or rectum) into or beyond the vaginal walls due to a loss of support from the pelvic floor muscles, endopelvic fascia, and perineal body.
Types of Prolapse
- Cystocele: Prolapse of the anterior vaginal wall (bladder).
- Rectocele: Prolapse of the posterior vaginal wall (rectum).
- Uterine/Apical Prolapse: Descent of the uterus or vaginal vault.
- Enterocele: Herniation of the small bowel into the upper posterior vaginal wall.
Clinical Presentation
| Presentation | Key Clinical Features |
|---|---|
| Symptoms | Pelvic pressure, “dragging” sensation, vaginal bulge, urinary urgency, or bowel dysfunction. |
| Exam | Use the Pelvic Organ Prolapse Quantification (POP-Q) system for staging. |
High-Yield Exam Pearl:
- Risk Factors: Parity (vaginal birth), increasing age, chronic cough, obesity, and menopause (hypoestrogenism).
- Management: Conservative (pelvic floor muscle training, pessaries) vs. Surgical (colporrhaphy, sacrocolpopexy, or hysterectomy). Surgery is reserved for symptomatic patients who have failed conservative measures.