Epidemiology

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Etiology

• Etiology: insufficiency of the pelvic floor muscles and the ligamentous supportive structure of the uterus and vagina
• Risk factors:
  • Multiple vaginal deliveries and/or traumatic births (greatest risk factor)
  • Low estrogen levels (e.g., during menopause)
  • Increased intraabdominal pressure (due to, e.g., obesity, cough related to chronic lung disease and/or smoking, ascites, pelvic tumors, constipation)

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Pathophysiology

• Specific sites
  • Vaginal wall prolapse
    • Anterior vaginal wall prolapse: herniated anterior vaginal wall, which is often associated with a cystocele (descent of the bladder) or urethrocele (descent of the urethra); can be due to weakness of the pubocervical fascia; Most common type.
    • Posterior vaginal wall prolapse: herniated posterior vaginal wall, which is associated with a rectocele (descent of the rectum) or enterocele (herniated section of the intestines); can be due to weakness of the rectovaginal fascia
  • Uterine prolapse: descent of the uterus
  • Vaginal vault prolapse: descent of the apex of the vagina
  • Apical compartment prolapse: herniated uterus, cervix, or vaginal vault
  • Uterine procidentia: protrusion of all vaginal walls or cervix beyond the vaginal introitus

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Clinical features

• Feeling of pressure on or discomfort around the perineum (“sensation of vaginal fullness”)
• Lower back and pelvic pain (may become worse with prolonged standing or walking)
• Rectal fullness, constipation, incomplete rectal emptying
• Prolapse of the anterior (most common) or the posterior vaginal wall
• Weakened pelvic floor muscle and anal sphincter tone

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Diagnostics

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Treatment

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