vaginal prolapse

Etiology

• rectocele
• cystocele
• enterocele
• uterine prolapse

Pathology

• child-bearing & other causes of increased intra-abdominal pressure weaken muscles & connective tissue supporting the perineum

Clinical manifestations

• the uterus, rectum, bladder, urethra, small bowel, & vagina may begin to prolapse through the vaginal orifice
• symptoms may be present even with mild prolapse
  • pelvic pressure
  • back pain
  • urinary incontinence
  • fecal incontinence

Management

• if asymptomatic, not treatment is necessary
• the degree of prolapse & organs involved determine therapy
• mild cases
  • topical estrogen may be of benefit
  • pelvic muscle exercises may be of benefit
• symptomatic prolapse
  • pessary
  • transvaginal colpopexy
    • perioperative behavioral therapy with pelvic floor muscle training (Kegel exercises) of little value
    • retropubic midurethral sling
      • sacrospinous ligament fixation (SSLF)
      • uterosacral ligament suspension (ULS)
      • equivalent outcomes for SSLF vs ULS

More general terms

• vaginal disorder