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Management of Pelvic Organ Prolapse pp 19–30Cite as

Pelvic Organ Prolapse: Pathophysiology and Epidemiology

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Part of the book series: Urodynamics, Neurourology and Pelvic Floor Dysfunctions ((UNPFD))

Abstract

The pelvic floor is the bottom of the pelvic cavity. It consists of several components: peritoneum, pelvic viscera, endopelvic fascia, levator ani muscles, perineal membrane, and superficial genital muscles. The support for all these structures comes from connections to the bony pelvis and its attached muscles. Furthermore, viscera play an important role in forming the pelvic floor through their connections with structures, such as the cardinal and uterosacral ligaments [1]. For these reasons, it should not be considered as a single compartment but as a complex of structures in strong synergism, to ensure multiple functions. The interaction and integrity of muscular, connective, and nerve structures is essential to guarantee normal pelvic organ support. If one of these factors fails, the other might be able to compensate to a certain degree until pelvic organ prolapse occurs [2]. The International Urogynecological Association (IUGA) and International Continence Society (ICS), in their joint report, defined the prolapse 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). The presence of any such sign should be correlated with relevant POP symptoms. More commonly, this correlation would occur at the level of the hymen or beyond. Prolapse symptoms are vaginal bulging, pelvic pressure, bleeding, discharge, infection, splinting/digitation, and low back pain. These are generally worse at the times when gravity might make the prolapse worse (e.g. after long periods of standing or exercise) and better when gravity is not a factor, for example, lying supine.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, EOC—Beata Vergine Hospital, Mendrisio, Switzerland

    Andrea Braga & Giorgio Caccia

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  1. Andrea Braga
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  2. Giorgio Caccia
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Correspondence to Andrea Braga .

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Editors and Affiliations

  1. Department of Urology, Careggi University Hospital, Florence, Italy

    Vincenzo Li Marzi

  2. Urogynecology Unit, University of Insubria, Varese, Italy

    Maurizio Serati

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Braga, A., Caccia, G. (2018). Pelvic Organ Prolapse: Pathophysiology and Epidemiology. In: Li Marzi, V., Serati, M. (eds) Management of Pelvic Organ Prolapse. Urodynamics, Neurourology and Pelvic Floor Dysfunctions. Springer, Cham. https://doi.org/10.1007/978-3-319-59195-7_2

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  • DOI: https://doi.org/10.1007/978-3-319-59195-7_2

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