Skip to main content
SpringerLink
Log in

Pelvic Organ Prolapse: Diagnosis, Treatment, and Avoiding Complications

  • Reference work entry
  • First Online:
Handbook of Gynecology

  • 1927 Accesses

Abstract

Pelvic organ prolapse (POP) is defined as 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). Prolapse is extremely common and is one of the leading reasons for surgery in the United States.

The main symptom of prolapse is the sensation of bulge or pressure in the vagina. Severe prolapse may interfere with successful urination, defecation, or sexual function. Prolapse diagnosis is usually based on physical exam, though several formal staging systems exist. Asymptomatic or minimally symptomatic prolapse may not require any intervention. Patients with significant bother may elect to use a plastic device (pessary) to hold their prolapsed organs in place, or they may elect for surgery. There are a variety of surgical procedures for prolapse, depending on the patient’s health, preferences, degree, and location of prolapse.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 699.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Abdool Z, Thakar A, Sultan AH, Oliver RS. Prospective evaluation of outcome of vaginal pessaries versus surgery in women with symptomatic pelvic organ prolapse. Int Urogynecol J. 2011;22(3):273–8.

    Article  PubMed  Google Scholar 

  • Alnaif B, Drutz HP. Bacterial vaginosis increases in pessary users. Int Urogynecol J. 2000;11(4):219–23.

    Article  CAS  Google Scholar 

  • Arias BE, Ridgeway B, Barber MD. Complications of neglected vaginal pessaries: case presentation and literature review. Int Urogynecol J. 2008;19(8):1173–8.

    Article  Google Scholar 

  • Arnold MW, Stewart WR, Aguilar PS. Rectocele repair. Four years’ experience. Dis Colon Rectum. 1990;33(8):684–7.

    Article  CAS  PubMed  Google Scholar 

  • Baden WF, Walker T. Fundamentals, symptoms and classification. In: Baden WF, Walker T, editors. Surgical repair of vaginal defects. Philadelphia: J.B. Lippincott; 1992. p. p14.

    Google Scholar 

  • Barber MD, Maher C. Apical prolapse. Int Urogynecol J. 2013;24:1815–33.

    Article  PubMed  Google Scholar 

  • Barber MD, Brubaker L, Burgio KL, Richter HE, Nygaard I, Weidner AC, Menefee SA, Lukacz ES, Norton P, Schaffer J, Nguyen JN, Borello-France D, Goode PS, Jakus-Waldman S, Spino C, Warren LK, Gantz MG, Meikle SF. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA. 2014;311(10):1023–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bø K. Can pelvic floor muscle training prevent and treat pelvic organ prolapse? Acta Obstet Gynecol Scand. 2006;85(3):263–8.

    Article  PubMed  Google Scholar 

  • Braekken IH, Majida M, Engh ME, Bø K. Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. Am J Obstet Gynecol. 2010;203(2):170e1–7.

    Article  Google Scholar 

  • Brubaker L, Nygaard I, Richter HE, Visco A, Weber AM, Cundiff GW, Fine P, Chetti C, Brown MB. Two-year outcomes after sacrocolpopexy with and without Burch to prevent stress urinary incontinence. Obstet Gynecol. 2008;112(1):49–55.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JOL, Klarskov P, Shull BL, Smith ARB. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:10–7.

    Article  CAS  PubMed  Google Scholar 

  • Clemons JL, Aguilar VC, Tillinghast TA, Jackson ND, Myers DL. Patient satisfaction and changes in prolapse and urinary symptoms in women who were fitted successfully with a pessary for pelvic organ prolapse. Am J Obstet Gynecol. 2004;190(4):1025–9.

    Article  PubMed  Google Scholar 

  • Cormio L, Mancini V, Liuzzi G, Lucarelli G, Carrieri G. Cystocele repair by autologous rectus fascia graft: the pubovaginal cystocele sling. J Urol. 2015;194(3):721–7.

    Article  PubMed  Google Scholar 

  • Culligan PJ. Nonsurgical management of pelvic organ prolapse. Obstet Gynecol. 2012;119(4):852–60.

    Article  PubMed  Google Scholar 

  • Cundiff GW, Weidner AC, Visco AG, Bump RC, Addison WA. A survey of pessary use by members of the American Urogynecologic Society. Obstet Gynecol. 2000;95(6):931–5.

    CAS  PubMed  Google Scholar 

  • Cundiff GW, Amundsent CL, Bent AE, Coates KW, Schaffer JI, Strohbehn K, et al. The PESSRI study: symptom relief outcomes of a randomized crossover trial of the ring and Gellhorn pessaries. Am J Obstet Gynecol. 2007;196(4):405–8.

    Article  PubMed  Google Scholar 

  • Dancz C, Walker D, Thomas D, Ó¦zel B. Prevalence of hydronephrosis in women with advanced pelvic organ prolapse. Urology. 2015;86(2):250–4.

    Article  PubMed  Google Scholar 

  • DeLancey JO. Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol. 1992;166(6 Pt 1):1717–24. discussion 1724-28

    Article  CAS  PubMed  Google Scholar 

  • Drake R, Vogl AW, Mitchell AWM, Ribbits R, Richardson P. Gray’s Atlas of anatomy. Philadelphia: Elsevier Health Sciences; 2008. p. 229.

    Google Scholar 

  • Evans J, Silva WA, Karram MM. Obliterative procedures for pelvic organ prolapse. In: Walters MD, Karram MM, editors. Urogynecology and reconstructive pelvic surgery. 4th ed. Philadelphia: Saunders; 2015.

    Google Scholar 

  • FitzGerald MP, Richter HE, Siddique S, Thompson P, Zyczynski H. Colpocleisis: a review. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(3):261–71.

    Article  PubMed  Google Scholar 

  • Francis W, Jeffcoate T. Dyspareunia following vaginal operations. J Obstet Gynaecol Br Commonw. 1961;68:1–10.

    Article  CAS  PubMed  Google Scholar 

  • Hagen S, Stark D, Glazener C, Sinclair L, Ramsay I. A randomized controlled trial of pelvic floor muscle training for stages I and II pelvic organ prolapse. Int Urogynecol J. 2009;20(1):45–51.

    Article  Google Scholar 

  • Hanson LA, Schulz JA, Flood CG, Cooley B, Tam F. Vaginal pessaries in managing women with pelvic organ prolapse. Obstet Gynecol. 2006;108(1):93–9.

    Article  Google Scholar 

  • Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN. An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction. NeurourolUrodyn. 2010;29:4–20.

    Google Scholar 

  • Hsu Y, Chen L, Summers A, Ashton-Miller JA, DeLancey JO. Anterior vaginal wall length and degree of anterior compartment prolapse seen on dynamic MRI. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(1):137–42.

    Article  PubMed  Google Scholar 

  • Hui SY, Chan SC, Lam SY, Lau TK, Chung KH. A prospective study on the prevalence of hydronephrosis in women with pelvic organ prolapse and their outcomes after treatment. Int Urogynecol J. 2011 Dec;22(12):1529–34.

    Article  PubMed  Google Scholar 

  • Inmon WB. Pelvic relaxation and repair including prolapse of vagina following hysterectomy. South Med J 1963;56:577–82.

    Article  CAS  PubMed  Google Scholar 

  • Karram MM, Ridgeway BM, Walters MD. Surgical treatment of vaginal apex prolapse. In: Walters MD, Karram MM, editors. Urogynecology and reconstructive pelvic surgery. 4th ed. Philadelphia: Elsevier; 2015.

    Google Scholar 

  • Koelbl H, Igawa T, Salvatore S, Laterza RM, Lowry A, Sievert KD, Sultan A. Pathophysiology of urinary incontinence, faecal incontinence and pelvic organ prolapse. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence. 5th ed. Paris: European Association of Urology; 2013.

    Google Scholar 

  • Lone F, Thakar R, Sultan AH, Karamalis G. A 5-year prospective study of vaginal pessary use for pelvic organ prolapse. Int J Gynecol Obstet. 2011;114(1):56–9.

    Article  Google Scholar 

  • Lopez A, Anzen B, Bremmer S, Mellgren A, Nilsson BY, Zetterstrom J, et al. Durability of success after rectocele repair. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12:97–103.

    Article  CAS  PubMed  Google Scholar 

  • Maher C. Midline rectovaginal fascial plication for repair of rectocele and obstructed defecation. Obstet Gynecol. 2004;104(4):685–9.

    Article  PubMed  Google Scholar 

  • Maher C, Karram M. Surgical management of anterior vaginal wall prolapse. In: Maher C, Karram M, editors. Surgical management of pelvic organ prolapse. 1st ed. Philadelphia: Saunders, an imprint of Elsevier; 2013.

    Google Scholar 

  • Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;(4).

    Google Scholar 

  • Margulies RU, Rogers MA, Morgan DM. Outcomes of transvaginal uterosacral ligament suspension: systematic review and meta-analysis. Am J Obstet Gynecol. 2010;202(2):124–34.

    Article  PubMed  Google Scholar 

  • Meeks GR, Washburne JF, McGehee RP, Wiser WL. Repair of vaginal vault prolapse by suspension of the vagina to iliococcygeus (prespinous) fascia. Am J Obstet Gynecol. 1994;171(6):1444–52;discussion 52–4.

    Google Scholar 

  • Mellgren A, Anzen B, Nilsson BY, Johansson D, Dolk A, Gillgren P, et al. Results of rectocele repair. A prospective study. Dis Colon Rectum. 1995;38(1):7–13.

    Article  CAS  Google Scholar 

  • Menefee A, Dyer Y, Lukacz S, Simsiman J, Luber M, Nguyen N. Colporrhaphy compared with mesh or graft-reinforced vaginal paravaginal repair for anterior vaginal wall prolapse: a randomized controlled trial. Obstet Gynecol. 2011;118(6):1337–44.

    Article  PubMed  Google Scholar 

  • Natale F, La Penna C, Padoa A, Agostini M, Panei M, Cervigni M. High levator myorrhaphy versus uterosacral ligament suspension for vaginal vault fixation: a prospective, randomized study. Int Urogynecol J Pelvic Floor Dysfunct. 2010;21(5):515–22.

    Article  Google Scholar 

  • Nguyen N, Burchette J. Outcome after anterior vaginal prolapse repair: a randomized controlled trial. Obstet Gynecol. 2008;111(4):891–8.

    Article  PubMed  Google Scholar 

  • Nygaard IE, McCreery R, Brubaker L, Connolly A, Cundiff G, Weber A, Zycynski H. Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol. 2004;104(4):805–23.

    Article  PubMed  Google Scholar 

  • Nygaard I, Brubaker L, Zyczynski H, Cundiff G, Richter H, Gantz M, Fine P, Menefee S, Ridgeway B, Visco A, Warren LK, Zhang M, Meikle S. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309(19):2016–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6.

    Article  CAS  PubMed  Google Scholar 

  • Paraiso MFR, Barber MD, Muir TW, Walters MD. Rectocele repair: a randomized trial of three techniques including graft augmentation. Am J Obstet Gynecol. 2006;195:1762–71.

    Article  PubMed  Google Scholar 

  • Roberge RJ, Keller C, Garfinkel M. Vaginal pessary-induced mechanical bowel obstruction. J Emerg Med. 2001;20(4):367–70.

    Article  CAS  PubMed  Google Scholar 

  • Rogo-Gupta L, Le NB, Raz S. Foreign body in the bladder 11 years after intravaginal pessary. Int Urogynecol J. 2012;23:1311–3.

    Article  Google Scholar 

  • Romanzi L, Chaikin D, Blaivas J. The effect of genital prolapse on voiding. J Urol. 1999;161(2):581–6.

    Article  CAS  PubMed  Google Scholar 

  • Rooney K, Kenton K, Mueller ER, FitzGerald MP, Brubaker L. Advanced anterior vaginal wall prolapse is highly correlated with apical prolapse. Am J Obstet Gynecol. 2006;195(6):1837–40.

    Article  PubMed  Google Scholar 

  • Shull BL, Capen CV, Riggs MW, Kuehl TJ. Bilateral attachment of the vaginal cuff to iliococcygeus fascia: an effective method of cuff suspension. Am J Obstet Gynecol. 1993;168(6 Pt 1):1669–74.

    Article  CAS  PubMed  Google Scholar 

  • StĂ¼pp L, Resende APM, Oliveira E, Castro RA, GirĂ£o MJBC, Sartori MGF. Pelvic floor muscle training for treatment of pelvic organ prolapse: an assessor-blinded randomized controlled trial. Int Urogynecol J. 2011;22(10):1233–9.

    Article  PubMed  Google Scholar 

  • Sudhakar A, Reddi V, Schein M, Gerst P. Bilateral hydroureter and hydronephrosis causing renal failure due to a procidentia uteri: a case report. Int Surg. 2001;86:173–5.

    CAS  PubMed  Google Scholar 

  • Sze EH, Karram MM. Transvaginal repair of vault prolapse: a review. Obstet Gynecol. 1997;89(3):466–75.

    Article  CAS  PubMed  Google Scholar 

  • Thubert T, Deffieux X. Inside out: on rare occasions, ring pessaries can cause genital incarceration. Am J Obstet Gynecol. 2014;210(3):278.e1.

    Article  PubMed  Google Scholar 

  • Trowbridge ER, Fenner DE. Practicalities and pitfalls of pessaries in older women. Clin Obstet Gynecol. 2007;50(3):709–19.

    Article  PubMed  Google Scholar 

  • Weber A, Walters M, Piedmonte M, Ballard L. Anterior colporrhaphy: A randomized trial of three surgical techniques. Am J Obstet Gynecol. 2001;185:1299–306.

    Article  CAS  PubMed  Google Scholar 

  • Wheeler LD, Lazarus R, Torkington J, O’Mahony MS, Woodhouse KW. Lesson of the week: perils of pessaries. Age Ageing. 2004;33(5):510–1.

    Article  PubMed  Google Scholar 

  • Wu JM, Hundley AF, Fulton RG, Myers ER. Forecasting the prevalence of pelvic floor disorders in U.S. Women: 2010 to 2050. Obstet Gynecol. 2009;114(6):1278–83.

    Article  PubMed  Google Scholar 

  • Wu JM, Kawasaki A, Hundley AF, Dieter AA, Myers ER, Sung VW. Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050. Am J Obstet Gynecol. 2011;205(3):230.e1–5.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Southern California, Los Angeles, CA, USA

    Christina Dancz

  2. Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA

    Morgan Elizabeth Fullerton

Authors
  1. Christina Dancz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Morgan Elizabeth Fullerton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christina Dancz .

Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA

    Donna Shoupe

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this entry

Cite this entry

Dancz, C., Fullerton, M.E. (2017). Pelvic Organ Prolapse: Diagnosis, Treatment, and Avoiding Complications. In: Shoupe, D. (eds) Handbook of Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-17798-4_70

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-17798-4_70

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-17797-7

  • Online ISBN: 978-3-319-17798-4

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation