Pelvic organ prolapse

What it is

Pelvic organ prolapse is the descent of the pelvic organs into and through the vagina. It follows relaxation, weakness or a defect in the cardinal and uterosacral ligaments, which normally maintain the uterus in the anteflexed position and prevent it from descending through the urogenital diaphragm, that is the levator ani muscles. The cardinal, pubocervical and uterosacral ligaments are the main support; the round ligament is not, and the uterosacral ligament is also the one that prevents retroversion.

Vaginal prolapse is named by the compartment that gives way: anterior, holding the cystocele and ureterocele; posterior, holding the rectocele and enterocele; and apical, the vaginal vault seen after hysterectomy, and the cervix.

Causes and risk

• Obstetric: multiparity and vaginal childbirth, instrumental delivery, prolonged labor
• Aging, and decreased estrogen after menopause
• Pelvic injury: hysterectomy and other pelvic surgery
• Connective tissue and collagen disorders, such as Marfan and Ehlers Danlos
• Increased intra-abdominal pressure: constipation, chronic cough, heavy lifting, obesity, ascites
• Congenital, rarely
• Ethnicity: Caucasian women more than Asian or African women