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Pelvic Organ Prolapse: Pathophysiology and Epidemiology

  • Andrea BragaEmail author
  • Giorgio Caccia
Chapter
Part of the Urodynamics, Neurourology and Pelvic Floor Dysfunctions book series (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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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyEOC—Beata Vergine HospitalMendrisioSwitzerland

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