First principle: prolapse is a support failure, described by compartment
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Risk factors: vaginal childbirth, ageing, menopause (tissue quality), obesity, chronic cough/constipation, connective‑tissue predisposition, prior pelvic surgery. Symptoms often emerge years after obstetric injury.
Describing it: degrees vs POP‑Q
- Traditional first/second/third degree (third‑degree complete = procidentia).
- Modern standardised POP‑Q, measured against the hymen: negative = above, 0 = at, positive = beyond. Learn the principle; both languages appear in practice.
The governing management principle
Management ladder
| Approach | Notes |
|---|---|
| Conservative | risk‑factor modification (constipation, cough, weight), pelvic‑floor muscle training |
| Pessary | mechanical support; ideal if surgery undesired/unsafe; needs fitting + follow‑up |
| Local vaginal estrogen | improves atrophic tissue comfort — not a mechanical cure |
| Surgery | correct the specific defective compartment(s); vault suspension; colpocleisis if intercourse no longer desired |
Red flags / cautions 🚩
- Transvaginal synthetic mesh for prolapse carries serious complications and is restricted in many countries — not a routine first choice.
Pitfalls
- Equating cystocele with stress incontinence — they coexist but are not synonymous.
- Operating on asymptomatic anatomy.
Pearls
- 🎯 Anterior = cystocele; posterior = rectocele/enterocele; apical = uterine/vault. Modern measure = POP‑Q.
- 🩺 A well‑fitted pessary is definitive management for many women — offer it before surgery.
Next → From structure to infection ascending those very passages (Concept 26).