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R. Edward Varner
Jonathan L. Gleason Holly E. Richter
Pelvic organ prolapse is an increasingly common condition seen in women with the aging of the population.
Causes of pelvic organ prolapse are multifactorial and contribute to the weakening of the pelvic support connective tissue and muscles as well as nerve damage.
Patients may be asymptomatic or have significant symptoms such as those related to the lower urinary tract, pelvic pain, defecatory problems, fecal incontinence, back pain, and dyspareunia.
Physical examination includes thoughtful attention to all parts of the vagina, including the anterior, apical, and posterior compartments, levator muscle, and anal sphincter complex.
Nonsurgical treatment options include pelvic ﬂoor muscle training and the use of intravaginal devices.
Surgical treatment involves an individualized, multicompartmental approach consistent with the patient’s previous treatment attempts, activity level, and health status.
Studies are needed to determine the characteristics of those patients who would derive long-term benefit from vaginal versus abdominal approaches to the surgical repair of pelvic organ prolapse.
Pelvic organ prolapse (POP) is a bulge or protrusion of pelvic organs and their associated vaginal segments into or through the vagina (1). It is a common and costly afﬂiction of older women (2,3). It has been estimated that over the next 30 years, the demand for treatment of POP will increase 45%, commensurate with an increase in the population of women older than 50 years of age (4,5). As this problem grows in significance, it becomes increasingly important to comprehend the pathophysiology and risk factors associated with pelvic organ prolapse and try to prevent its occurrence. Furthermore, continued efforts are needed to understand factors that result in long-lasting, robust repair of pelvic organ prolapse for those patients undergoing surgical management. Despite extensive anecdotal experience, the optimal surgical approach to apical and other compartment prolapse remains elusive (6).