Concurrent pelvic symptoms accompany POP in patients [11]. Ellerkmann et al in 2011 reported the following in 237 women: urinary incontinence, 73%; urinary urgency, 86%; urgency and/or frequency, 34 to 62 %; voiding dysfunction and faecal incontinence, 31% [12]. Evaluation of POP requires knowledge of the symptomatology of pelvic floor disorders and their effects on quality of life. Carefully designed psychometric self-administered questionnaires are used to validate the occurrence and and impact of POP symptoms on a patient's sense of well-being and capacity to resume normal activities. 

Research has improved understanding of the association between loss of pelvic organ support and severity of symptoms, the most consistent of which is the presence of a vaginal protrusion that can be seen or felt by patients with advanced POP. The absence of this vaginal bulge after surgery has a significant effect on a patient’s perception of overall improvement more than anatomical success alone. The hymen being an important outcome indicator, women with prolapse beyond the hymen are more likely to have pelvic floor symptoms and vaginal bulge than those with prolapse at or above the hymen.

• Falling

  Learn what can cause the vagina and other pelvic organs to fall from their normal position. Vaginal prolapse happens when the vagina falls from its normal location inside the pelvis toward the opening of the vagina. [everydayhealth.com]

  Uterine prolapse When the ligaments which support the uterus are damaged, the uterus can fall into the vagina or even outside. [wcwsc.com]

  Vaginal prolapse happens when the organs inside your pelvis fall, bulge or protrude into the soft vaginal wall. [poise.com.au]

  There are a number of different types of prolapse: Bladder prolapse (cystocoele) When the bladder prolapses, it falls towards the vagina and creates a large bulge in the front vaginal wall. [nottinghamurologygroup.co.uk]

  A vaginal prolapse is a condition when organs such as the uterus, rectum, bladder, urethra, small bowel, or the vagina itself may begin to prolapse, or fall out of their normal positions. [kegel8.co.uk]

• Asymptomatic

  Asymptomatic urinary tract infections (pus cells > 5 per High Power Field) occured in nine (18%) in group A and fifteen (30%) in group B (P value 0.16). [ncbi.nlm.nih.gov]

  In some cases, the condition is asymptomatic (i.e., does not cause symptoms). The most common sign of the condition is a sensation that structures in the pelvis are out of place. [healthcommunities.com]

  Pelvic organ prolapse is usually classified as asymptomatic (mild) or symptomatic (serious). Asymptomatic means the organs drop but do not extend beyond the vaginal opening. Symptomatic means the organs or tissue extend beyond the vaginal opening. [drugwatch.com]

• Recurrent Urinary Tract Infection

  General symptoms include pressure in the vagina or pelvis (usually decreases when lying down), painful intercourse (dyspareunia), and recurrent urinary tract infections (UTI). In some cases, a lump or mass develops at the vaginal opening. [healthcommunities.com]

  urinary tract infections The following are symptoms that are specific to certain types of vaginal prolapse: Difficulty emptying bowel – may indicate vaginal vault prolapse (when the upper part of the vagina loses its normal shape and sags into the vaginal [obgyn.med.miami.edu]

• Infertility

  […] tissues During pregnancy and labour helps to soften the vaginal canal enabling easy delivery and easy expulsion of placenta Promotes laxity of the pelvic floor muscles to enable normal labour Strengthens the vaginal muscles Treats inflammation, erosions, infertility [practo.com]

  […] have expertise in general urologic care, female urology, kidney and urinary tract disease, kidney stones, urinary incontinence, benign prostatic hyperplasia, urologic cancers (prostate, bladder, testicular, kidney, adrenal), vasectomy reversal, male infertility [mountsinai.org]

  […] urinating Chronic abdominal pressure, swelling and bloating Difficulty with bowel movements Slipping of the uterus or vagina Frequent urinary tract infections Pressure sensations in the pelvic area or on the bladder or rectum Pain while walking or standing Infertility [mivip.com]

  Call now Ayurveda Jan Sevak Chikitsalaya Call now Posted on 06-Jan-2020 Gynecologist - Cures for vaginosis, infertility, fallopin tube closure, lump formation in uterus, etc. are treated by Ayurvedic method. [ayurveda-jan-sevak-clinic.business.site]

  Practical utilization of the knowledge about endometrial factors during the human embryo implantation may sufficiently facilitate infertility treatment in the future. 1. Mazur EC, Large MJ, DeMayo FJ. [monz.pl]

• Chronic Cough

  Other risk factors include surgery to the pelvic floor, obesity, family history, chronic constipation and excessive bearing down in bowel movements, heavy lifting, aggressive exercise, age, chronic coughing and having a neuromuscular disease such as multiple [denverurology.com]

  Possible causes include: Pregnancy and childbirth Ageing and the menopause Obesity Chronic cough or straining (eg constipation, heavy lifting) Previous pelvic surgery Neurological conditions Pregnancy Pelvic organ prolapse is very common: around half [nottinghamurologygroup.co.uk]

  The common factors such as frequent lifting of heavy objects, chronic cough, severe constipation, menopause, childbirth, and pregnancy may increase your risk of developing utero-vaginal prolapse. [vashevnik.com.au]

  cough; abnormalities of the connective tissue; prior pelvic surgery; advanced age; and chronic constipation. [academic-urology.com]

• Diarrhea

  Risk factors for rectal prolapse include conditions associated with straining such as chronic constipation or diarrhea, nerve and muscle weakness (paralysis or multiple sclerosis), and advancing age are risk. [voicesforpfd.org]

  Other symptoms may include: Pain during bowel movements Mucus or blood discharge from the protruding tissue Loss of bowel control Risk factors for rectal prolapse include conditions associated with straining such as chronic constipation or diarrhea, nerve [uclahealth.org]

• Intestinal Disease

  Conditions, Anatomical Urinary Bladder Diseases Urologic Diseases Pelvic Organ Prolapse Uterine Diseases Genital Diseases, Female Rectal Diseases Intestinal Diseases Gastrointestinal Diseases Digestive System Diseases Hernia [clinicaltrials.gov]

• Ulcer

  We report a case of an 84-years-old lady, who presented with long standing vaginal ulcer in association with third degree uterovaginal prolapse. Incisional biopsy was taken from the ulcer. [ncbi.nlm.nih.gov]

  Vaginal mucosa may become dried, thickened, chronically inflamed, secondarily infected, and ulcerated. Ulcers may be painful or bleed and occasionally resemble vaginal cancer. The cervix, if protruding, may also become ulcerated. [merckmanuals.com]

  Regular examinations are necessary to change the pessary and to check for complications such as ulceration or bleeding. Any aggravating factors such as chronic cough will need to be treated. [kkh.com.sg]

• Back Pain

  Symptoms of Pelvic Organ Prolapse Lower back pain is one of the symptoms of pelvic organ prolapse Symptoms of prolapse develop gradually as pelvic floor muscles weaken. [drugwatch.com]

  However, women with more severe forms of prolapse may experience Sensation of pulling in the lower abdomen or pelvis An uncomfortable feeling of fullness in the vagina Low back pain Urinary problems, such as urine leakage or urine retention Difficulty [vashevnik.com.au]

  Sometimes it is impossible to know whether a symptom, for example back pain, is due to prolapse or something else, & you may not know the answer until after the treatment. [wcwsc.com]

  Incontinence symptoms associated with your vaginal prolapse, bulging feelings, pelvic pain, and back pain have all been shown to improve in most women with management or vaginal prolapses in this manner. [fixprogram.com]

• Muscle Weakness

  Sometimes, this is caused by weak supporting pelvic tissues and muscles. Childbirth, chronic cough, age, and constipation can lead to this pelvic muscle weakness. [utswmedicine.org]

  In a pelvic floor strength test, potential muscle weakness is measured as the patient uses his or her pelvic floor and sphincter muscles. If the prolapse is at an early stage, an MRI, X-ray, ultrasound, colonoscopy or cystoscopy can detect it. [drugwatch.com]

  Risk factors for rectal prolapse include conditions associated with straining such as chronic constipation or diarrhea, nerve and muscle weakness (paralysis or multiple sclerosis), and advancing age are risk. [voicesforpfd.org]

  Although the specific causes of POP are unknown, there are risk factors for developing POP that are related to tissue, nerve or muscle weakness or damage. [lhsc.on.ca]

• Low Back Pain

  However, women with more severe forms of prolapse may experience Sensation of pulling in the lower abdomen or pelvis An uncomfortable feeling of fullness in the vagina Low back pain Urinary problems, such as urine leakage or urine retention Difficulty [vashevnik.com.au]

  You have continuing low back pain with difficulty in walking, urinating, and moving your bowels. [webmd.com]

  If pelvic pain, low back pain, or pain with intercourse is present before surgery, the pain may persist after surgery. Symptoms of urinary retention may return or get worse following surgery. [cigna.com]

• Confusion

  “In regards to surgical treatments, there is much confusion on whether mesh should be used for support of the pelvic tissues,” Dr. Portera explains. [wishdocs.com]

  […] text योनिनिरय m. yoniniraya womb compared to a hell योनिपोषण n. yonipoSaNa growing of seed or grain योनिभ्रंश m. yonibhraMza fall of the womb योनिभ्रंश m. yonibhraMza prolapsus uteri योनिरञ्जन n. yoniraJjana menstrual excretion योनिसङ्कर m. yonisaGkara confusion [spokensanskrit.org]

  It can be confused with a large hemorrhoid. Other symptoms may include: Pain during bowel movements. Mucus or blood discharge from the protruding tissue. Loss of control of bowel movements. [voicesforpfd.org]

  Getting a little confused? Here’s a quick breakdown of the types of vaginal prolapse : • Cystocele (aka, dropped bladder): when the front wall of the vagina prolapses and the bladder than drops into the vagina. [naturallysavvy.com]

• Dyspareunia

  Dyspareunia was described in 70 studies for a rate of 9.1%, (95% CI, 8.2 - 10.0%; range, 0 - 66.7%; synthetic, 8.9%; biological, 9.6%). [ncbi.nlm.nih.gov]

  General symptoms include pressure in the vagina or pelvis (usually decreases when lying down), painful intercourse (dyspareunia), and recurrent urinary tract infections (UTI). In some cases, a lump or mass develops at the vaginal opening. [healthcommunities.com]

• Vaginal Discharge

  Do not plan a long trip even as a passenger for at least a couple of weeks after your discharge from hospital. Gentle swimming is fine once all vaginal discharge has settled Prevent constipation – Avoid straining when opening your bowels. [agsc.com.au]

  Side effects of vaginal pessaries Vaginal pessaries can occasionally cause: unpleasant smelling vaginal discharge, which could be a sign of an imbalance of the usual bacteria found in your vagina (bacterial vaginosis) some irritation and sores inside [nhs.uk]

  Things to consider You may notice more vaginal discharge than normal when using a pessary. Your vaginal discharge may also develop an odor. Certain vaginal gels can help with these side effects. [familydoctor.org]

  For the first few days or weeks after your operation, you may have some vaginal bleeding similar to a period. You may also have some vaginal discharge. This may last three or four weeks. [nhsinform.scot]

• Urinary Retention

  Urinary incontinence. Urinary retention. Infection. Formation of an abnormal opening or connection between organs or body parts ( fistula ). [cigna.com]

  Urinary incontinence. Urinary retention. Infection. Formation of an abnormal opening or connection between organs or body parts (fistula). [uwhealth.org]

  The association between Post-operative urinary retention, pus cells count > 5 per High Power Field, bacterial culture positivity and the length of catheterization were assessed by Chi square test. [ncbi.nlm.nih.gov]

• Urinary Urgency

  Ellerkmann et al in 2011 reported the following in 237 women: urinary incontinence, 73%; urinary urgency, 86%; urgency and/or frequency, 34 to 62 %; voiding dysfunction and faecal incontinence, 31%. [symptoma.com]

  Symptoms Symptoms may include: Pelvic pressure A feeling of vaginal fullness or heaviness A feeling of pulling in the pelvis Vaginal discomfort Urinary urgency and frequency Urination when laughing, sneezing, coughing, or exercising Constipation Difficult [lahey.org]

  This procedure is especially valuable for women who have symptoms of urinary urgency, frequency, bladder pain, or blood in the urine. It is usually performed in the office using local anesthesia. [obgyn.med.miami.edu]

  urgency and frequency Urination when laughing, sneezing, coughing, or exercising Constipation Difficult or painful intercourse Low backache that is relieved with lying down Diagnosis You will be asked about your symptoms and medical history. [winchesterhospital.org]

• Incomplete Bladder Emptying

  If a woman has pelvic organ prolapse, she may have one or more of the following symptoms: Protrusion of a tissue or a bulge in the vagina or rectum Pelvic pressure Urinary symptoms such as slow urinary stream, a feeling of incomplete bladder emptying, [nm.org]

  Urinary problems such as slow stream, a feeling of incomplete bladder emptying, frequency, urgency and stress urinary incontinence. Bowel problems such as difficulty moving the bowel or a feeling of not emptying properly. [bladderandbowel.org]

  Rates of bladder perforation, urinary tract infection, major bleeding complications, and incomplete bladder emptying in the first 6 weeks after surgery were all higher in the sling group than in the sham group (Table 4). [nejm.org]

  bladder emptying 6 weeks after surgery (3.7% vs 0%) (P≤.05 for all).14 CASE 1 Recommendations for this patient For this case, we would offer the patient a transvaginal hysterectomy and USLS. [mdedge.com]

  Feeling of incomplete bladder emptying. Weak or prolonged urinary stream. The need to reduce the prolapse manually before voiding. The need to change position to start or complete voiding. Coital difficulty Dyspareunia. Loss of vaginal sensation. [patient.info]

Routine laboratory examinations:

• Rule out infections: creatinine, glucose, BUN, and calcium, in patients with polyuria or compromised renal function. 
• Urinalysis with cytology, for patients with hematuria, to rule out bladder neoplasm.

Imaging Studies:

• Ultrasonographic imaging of the uterus.
• Contrast radiology, MRI, and ultrasonography, to identify the support defects.
• Proctography and proctosigmoidoscopy, for  defecatory dysfunction. 
• Colonic transit studies, for peristaltic dysfunctions.
• Dynamic MRI defecography, for defecatory and high-quality soft tissue imaging; however, the test is expensive and inconclusive.

Diagnostic Procedures:

• Cervical cytology.
• Ultrasonography or endometrial biopsy, to rule out endometrial pathology, for patients undergoing LeFort colpocleisis. 
• Urodynamic testing, for urinary incontinence. 
• Cystoscopy, for refractory patients with hematuria, bladder pain, or urinary urgency, and polyuria.
• Cervical cytology, in lieu of cervical screening.  

The overall prevalence of POP is 31%, increasing with age. By age 80, the probability of requiring surgical intervention is approximately 11%; 29 to 40% undergo reoperation within 3 years after traditional surgery using non-augmented vaginal techniques (culdoplasty, colporrhaphy, and apical vault suspensions). As it were, high failure rates prompted the use of grafts, but without standardized techniques, have had varied outcomes [13]. Pelvic floor graft in the form of tension-free vaginal tape and sacral colpopexy have had long-term restorative benefits. Complications from sacral colpopexy may be increased by laparotomy; as an alternative, laparoscopy, may provide comparable success and faster convalescence time.

Various types of grafts may be used: xenografts (porcine dermis, intestinal mucosa), allografts (cadaveric), or synthetic material (polypropylene). Recent developments focus on TVM (transvaginal mesh) systems using polyproplylene graft material and trocars. The methodology aims for durability, minimize invasiveness and patient apprehension, provide regional anaesthesia, and repair anatomical defects  without trimming the vagina or suturing the mesh to the vagina. Selective application of vaginal implants eliminates the need for hysterectomy. Trocars are installed via the obturator membrane or the ischiorectal fossa. 

TVM systems have been shown to be effective but long-term follow-up on safety and longevity has been limited. Side effects (mesh erosion and shrinkage, dyspareunia, pelvic pain, and stress incontinence) were observed in earlier studies. Newer technology has made possible single-incision trocarless TVM systems, minimizing the side effects and shortening operating time. Potential risks and effectiveness  of these procedures remain to be elucidated [14] [15].

Recommendations:

• Patients should be informed that the TVM systems have been developed from previous uncontrolled short-term studies with considerable success of anatomical cure. Meanwhile further evidence is needed to establish their advantage over other currently used methods.
• Training on TVM procedures should be instituted. 
• Patients should be advised on (a) potential side effects of transvaginal mesh repairs; (b) limitations of traditional treatment modalities and more recent procedures; and (c) that the effectiveness of trocarless kits remains to be investigated. 

The success of anterior colporrhaphy depends on the physician's competence in performing the operation; failure rates of 0 to 20% have been reported. Paravaginal repairs via the vaginal route have been successful in 76 to 98% of cases within one year period of observation . However, controlled prospective studies are needed for more conclusive evidence of long-term benefits from this procedure.

At one year follow up, treatment with traditional posterior vaginal repair was successful in 76 to 96% of cases while posterior colporrhaphy benefited 80 to 90% patients. Defect-specific colporrhaphy resulted in the resolution of symptoms associated with rectocele,  including reduction in splinting, 55%; dyspareunia, 66% and constipation, 84% [10].  Transanal repair alleviated constipation in 22 to 85% of patients. A comparative trial of transvaginal and transanal operation showed the transvaginal procedure to be more effective for symptomatic relief, with less likelihood for recurrence and development of postoperative enterocele.

Abdominal sacrocolpopexy surgery resulted in 88 to 100% cure rate of enterocoele at 2-year follow-up. Vaginal sacrospinous ligament fixation was successful in 88% at 6 weeks and 97% after one year postoperation. The rate of recurrence of POP was less after abdominal sacrocolpopexy than with vaginal sacrospinous ligament fixation. However, recovery was faster in the latter and required less intraoperative time and expenses. A matched case control study of iliococcygeus suspension versus sacrospinous colpopexy showed parallel successful outcomes and complication rates. Modified McCall culdoplasty was successful in 88 to 93% of patients within 1-12 years follow up period. High cure rates of 87 to 89% have been reported in uterosacral ligament suspension. 

Vaginal childbirth is attended by damage to surrounding tissues; pregnancy per se is a risk factor. Handa et al in 2011 showed that vaginal childbirth increased the risk for POP and urinary incontinence 5 to 10 years after delivery vis-a-vis cesarean section without labor [4].

Exacerbating factors in POP:

• Neuropathies associated with labor, decreasing muscle tonicity thus, further sagging and stretching of the pelvic floor as seen in multiparous women. 
• Genital atrophy and hypoestrogenism, although the exact mechanism involved in the pathogenesis of vaginal prolapse is not fully understood.
• Diabetic neuropathy, pelvic tumors and sacral nerve disorders. 
• Increased intra-abdominal pressure due to obesity, constipation, COPD  and smoking 
• Connective tissue (collagen) abnormalities, such as Marfan disease. 

Thorough knowledge of multiple support defects is critical in the treatment of pelvic floor disorders in women [5].

Fewer epidemiological studies of POP as compared to urinary incontinence presumes that the symptoms are not specific enough for accurate assessment by conventional survey methods  especially during the early stages of the disease. Some studies rely on secondary data from case management, hospital and/or surgery databases instead of physical examination for vaginal prolapse. While more recent studies use standardized examination techniques, one study dealt with the incidence of posthysterectomy vault prolapse using both methodologies.  

The widely divergent prevalence rate of 2 to 48% of prolapse at the juncture  of the hymen is likely due to differences in the study population on age, race, parity and diagnostic techniques. In all four instances, prevalence rates increased with age except in the study of Bland et al in 1999 which had made no reference with regards to age [6]. Earlier, Olsen et al in 1997 calculated the age-specific incidence rate of surgery for POP in a large care managed population in Oregon [7], yet, epidemiological information on POP remains confined to the white population. 

The annual incidence rate of surgery for POP ranged between 0.4 per 10,000 and 34.3 per 10,000 in the 20-29 age group and in the 70-79 age group, respectively. Incidence rate in the latter group increased to 49 per 10,000 from the combined data on POP and POP with continence surgery versus continence surgery alone. A longitudinal study involving more than 17,000 women aged 25-39, enrolled between 1968 and 1974 was followed up for 26 years [8]. Thereupon, the annual incidence rate of hospital admission for prolapse was found to be 20.4 per 10,000 as compared to the annual incidence rate of surgery for prolapse of 16.2 per 10,000. No data is available on women who are treated but without hospitalization and surgery and those who never seek clinical intervention. The incidence and prevalence of POP based only on surgical cases do not truly reflect the magnitude of the problem in the general population. 

Marchionni et al estimated the 13 years incidence rates of prolapse following hysterectomy to be 0.2 to 0.4% whereas the incidence rate based on physical examination in the same population was more than tenfold  greater or 4.4% [9]. From extensive surgical database studies, the annual age-specific surgical incidence rate of POP requiring hysterectomy and pelvic surgery ranged from 10 to 30 per 10,000, the indication for surgery increasing with age. The overall prevalence rate of POP beyond the hymen (> Stage II) is estimated to be between 2 and 4% but probably much higher in the group seeking intensive clinical care. Well-designed population-based studies, with confirmatory physical examination are needed to ascertain the true status of POP in women.

POP involves a dysfunction in which the vagina and associated structures in the pelvis descend towards the vaginal orifice due to loss of support from the pelvic diaphragm. The condition is manifested in varying degrees of severity. At its worst stage the pelvic organs protrude completely through the vaginal canal and entails multiple defects in the various segments of the genital tract. 

Evidence of the efficacy of preventive interventions has not been commensurate with knowledge of risk factors in POP. In fact vaginal childbirth is by far the most important predisposing factor in the etiology of POP. Only as a last resort should planned caesarean section (CS) be considered for selected women with a strong likelihood of developing prolapse. CS entails further risk of postoperative complications and financial burden to the patient and the health care system.

Based on research efforts, a scoring system(UR-CHOICE) has been developed to assess the associated risks of pelvic floor dysfunction. These are:  body mass index, ethnicity, urinary incontinence before pregnancy, age of mother at birth of first child, family history (particularly females), baby's weight (<4 kg) and mother's height (<160 cm). In more sophisticated studies, variables such as genetics  and other relevant disease conditions (benign joint hypermobility syndrome, etc.) can be included in the assessment of POP [16].

Certain surgical procedures may or may not prevent recurrence of POP. For example, total hysterectomy, but not abdominal subtotal hysterectomy, is effective. McCall culdoplasty concomitant with vaginal hysterectomy are likewise preventive. Vaginal apical support procedure done during prolapse surgery may reduce the risk of recurrence in the long run.

Pelvic floor muscle training (PFMT) has been considered as an alternative measure. However, a recent study of a nurse-led PFMT with bladder training at 5, 7, and 9 months after delivery compared to standard rehabilitation methods showed no significant differences between groups at 12-year follow-up. An improved PFMT regimen consisting of individualised physiotherapy sessions, Pilates-based maintenance classes and one-on-one yearly check-ups is currently undergoing evaluation for POP prevention for a two-year follow-up period.

Occurrence of POP with urogenital atrophy presumes that hormone treatment with oestrogens, alone or in combination with other measures, may improve the condition of weakened supporting structures or the diaphragm heretofore, preventing prolapse. However, this remains to be confirmed.  Meanwhile, studies on hormone replacement therapy and lower urinary tract symptoms have shown that local oestrogen treatments are more beneficial than systemic administration. Rigorous longitudinal randomised controlled trials are needed to assess oestrogen's  proper place in POP prevention. 

Other POP preventive measures: 

• Avoidance of straining and intra-abdominal pressure.
• Treatment of bowel dysfunction and/or chronic constipation.
• Diet, for weight loss or bariatric surgery. Studies have shown subjective improvement in symptoms following weight reduction; however, no objective change was observed using the pelvic organ prolapse quantification (POP-Q) system.

Damage to muscle and nerve tissues in the pelvis causes the pelvic diaphragm to loose its capacity to hold the organs thereat in place leading to vaginal prolapse or pelvic organ prolapse (POP). Thereupon, the bladder, urethra, uterus, cervix, part of the small bowel, rectum and the vagina itself protrude towards the vaginal orifice through the vaginal canal, a condition sometimes called "pelvic hernia".

Risk factors in POP:

• Injury from vaginal delivery, radiation, and fractures 
• Hysterectomy and other surgical procedures. 
• Strenuous activities
• Smoking
• Obesity, 40 to 75% greater risk of POP.
• Aging, menopause, nerve, muscle, and connective tissue dysfunctions

The type of POP depends on where the damage occurs e.g., prolapse uteri, rectocele prolapse, bladder prolapse, etc. Multiple foci of prolapse may be present in the same patient [1] [2] [3].

The pelvic floor consists of supporting structures (nerves, muscle, connective tissue and ligaments) that altogether serve as a "hammock"  or diaphragm, holding various organs (uterus, vagina, cervix, bladder, urethra, part of the small intestine and rectum) in place. If any of these supporting structures are damaged, the diaphragm weakens, causing the pelvic organs to descend into the vaginal canal, and all the way to the vaginal orifice in severe cases. This protruding mass can be felt or seen and is sometimes regarded as "hernia" of the pelvic floor. The condition is called pelvic organ prolapse (POP) or simply, vaginal prolapse.

Pelvic floor disorders is common among women worldwide and risk increases with age. One in 11 women are likely to need surgical intervention for POP in their lifetime. The patient may feel discomfort or complain of problems with urination or bowel movements. A thorough examination is done of the pelvic area to expose the abnormalities. Pelvic muscle exercises and pessaries (vaginal suppositories) may help, but surgery may still be needed.

Factors that commonly predispose to POP:

• Pregnancy
• Vaginal childbirth, risk is less with cesarean section
• Frequent vaginal delivery, increased with each delivery
• Obesity
• Hysterectomy (removal of the uterus)
• Surgery for urinary incontinence
• Aging
• Increased pressure in the abdomen from ascites, chronic coughing, smoking, constipation, lifting heavy objects
• Neurological disorders, tumors, connective tissue abnormalities
• Congenital birth defects                 

1. Choi, K. H. & Hong, J. Y. (2014). Management of pelvic organ prolapse. Korean J Urol., 55(11), 693-702.
2. Siddiqui, N. Y, & Edenfield, A. L. (2014). Clinical challenges in the management of vaginal prolapse. Int J Womens Healt., 16(6), 83-94.
3. Barber, M. D. & Maher, C. (2013). Apical prolapse. Int Urogynecol J., 24(11), 1815-33.
4. Handa, V. L., Blomquist. J. L., Knoepp, L. R., et al. (2011). Pelvic floor disorders 5-10 years after vaginal and cesarean childbirth. Obstet Gynecol., 118, 777.
5. Vergeldt, T. F., Weemhoff, M., IntHout, J., & Kluivers, K. B. (2015, May 13). Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. (Abstract).
6. Bland, D. R., Earle, B. B., Vitolins., M. Z., &Burke, G. (1999). Use of the Pelvic Organ Prolapse Staging System of the International Continence Society, American Urogynecologic Society, and Society of Gynecologic Surgeons in perimenopausal women. Am J Obstet Gynecol., 181(6), 1324-7.
7. Olsen, A. L., Smith, V. J., Bergstrom, J. O., Colling, J. C., Clark, A. L. (1997). Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol., 89(4), 501-6.
8. Vessey, M., & Yeates, D. (2009). Some minor female reproductive system disorders: findings in the Oxford-Family Planning Association contraceptive study. J Fam Plann Reprod Health Care., 35(2),105-10.
9. Marchionni, M.,  Bracco, G. L., Checcucci, V., Carabaneanu, A., Coccia, E. M., Mecacci, F., & Scarselli, G. (1999). True incidence of vaginal vault prolapse. Thirteen years of experience. J Reprod Med., 44(8),679-84.
10. Dietz, V. & Maher, C . (2013). Pelvic organ prolapse and sexual function. Int Urogynecol J., 24(11), 1853-7.
11. Pahwa, A. K., Siegelman, E. S., & Arya, L. A. (2015). Physical examination of the female internal and external genitalia with and without pelvic organ prolapse: A review. Clin Anat., 28(3), 305-13.
12. Ellerkmann, R. M., Cundiff, G. W., Melick, C. F., Nihira, M. A., Leffler, K., & Bent, A.E. (2011). Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol., 185(6),1332-7.
13. Richter, L. A., Carter, C., & Gutman, R. E. (2014). Current role of mesh in vaginal prolapse surgery. Curr Opin Obstet Gynecol., 26(5), 409-14.
14. Costantini, E. & Lazzeri, M. (2015). What part does mesh play in urogenital prolapse management today? Curr Opin Urol., 25(4), 300-4.
15. Galczyński, K., Nowakowski, L., Romanek-Piva, K., & Rechberger, T. (2014). Laparoscopic mesh procedures for the treatment of pelvic organ prolapse--review of the literature. Ginekol Pol., 85(12), 950-4.
16. Giarenis, I. & Robinson, D. (2014, Sep 4). Prevention and management of pelvic organ prolapse. F1000Prime Rep., 6, 77.