Pelvic Organ Prolapse

Pelvic organ prolapse is the descent of parts of the pelvic organs, usually the vaginal wall or the uterus. Vaginal prolapse on the front wall of the vagina is called a cystocele as the bladder lies immediately above the front wall of the vagina. A prolapse on the back wall of the vagina, adjacent to the rectum, is therefore called a rectocele. There is also a common misconception that if a woman has had her uterus removed, she can no longer have any prolapse, but this is not the case.

Once the uterus is removed, the vagina is sewn over at the apex and becomes a blind-ending tube. This tube needs to be supported and, if not, it can prolapse as well. This post-hysterectomy vaginal prolapse is often referred to as vault prolapse. The management of this sort of weakness may require the insertion of plastic devices such as ring pessaries. Alternatively, if the prolapse is very mild, it might be responsive to good pelvic floor physiotherapy. If the condition progresses, it may require surgery. Surgery usually involves a vaginal repair or a possible hysterectomy, depending on what parts of the pelvis are descending.

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