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Pelvic Organ Prolapse

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Iglesia CB, Smithling KR. Pelvic Organ Prolapse. Am Fam Physician. 2017 Aug 1;96(3):179-185. Review. PubMed PMID: 28762694.

Pelvic organ prolapse is 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). Prevalence increases with age. The cause of prolapse is multifactorial but is primarily associated with pregnancy and vaginal delivery, which lead to direct pelvic floor muscle and connective tissue injury. Hysterectomy, pelvic surgery, and conditions associated with sustained episodes of increased intra-abdominal pressure, including obesity, chronic cough, constipation, and repeated heavy lifting, also contribute to prolapse. Most patients with pelvic organ prolapse are asymptomatic. Symptoms become more bothersome as the bulge protrudes past the vaginal opening. Initial evaluation includes a history and systematic pelvic examination including assessment for urinary incontinence, bladder outlet obstruction, and fecal incontinence. Treatment options include observation, vaginal pessaries, and surgery. Most women can be successfully fit with a vaginal pessary. Available surgical options are reconstructive pelvic surgery with or without mesh augmentation and obliterative surgery.

Pelvic organ prolapse is defined by herniation of the anterior vaginal wall, posterior vaginal wall, uterus, or vaginal apex into the vagina; descent may occur in one or more structures.1 Prolapse of pelvic structures can cause a sensation of pelvic pressure or bulging through the vaginal opening and may be associated with urinary incontinence, voiding dysfunction, fecal incontinence, incomplete defecation, and sexual dysfunction.

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