Pelvic Relaxation and Prolapse

By Joseph Hazan,M.D., FACOG

This is also known as Pelvic Organ

Prolapse (POP).

It consists of the descent of a pelvic organ

into or beyond the vagina,

perineum or anal canal.

When the bladder has prolapsed into

the vagina, there is anterior wall

prolapse and it is called cystocele.

If the urethra has prolapsed into the

vagina it is known as urethrocele.

When the rectum prolapses into the

vagina it is called a rectocele.

If the bowel has prolapsed into the

vagina this is known as enterocele.

These two are posterior to the vagina,

so they are considered posterior

wall prolapse.

The descent of the uterus is termed

uterine prolapse and if the vaginal

cuff is descended (in the absence of a

uterus), it is termed vaginal vault

prolapse. These two are considered

apical prolapse.

Based on the degree of descent the

prolapse can be grade 1,2, 3 or 4.

This condition is more prevalent after

 the age of 80.

The chances of a woman having prolapse

after menopause is in the range of 30-50%.

The risk is increased by a large number of

deliveries, especially difficult

vaginal deliveries. 

Obesity is a risk factor, so is also chronic constipation.

It is caused by weak pelvic muscles and straining

or strenuous lifting can

aggravate the condition.

In some cases incontinence can be encountered.

Sexual dysfunction can also be seen.

After examination and evaluation strengthening Kegel’s exercises are

recommended and in some cases a pessary can be beneficial.

If there is vaginal atrophy an estrogen cream is helpful. About 10% of

cases are treated with surgery.