The simple idea (no memorising)
The pelvic floor is a hammock. Over years, childbirth, ageing, menopause, chronic coughing or straining can stretch and weaken it, letting organs sag toward or through the vaginal opening.
Describe it by compartment:
- Anterior (front) — bladder bulges in → cystocele.
- Posterior (back) — rectum bulges in → rectocele.
- Apical (top) — the womb, or (after hysterectomy) the vaginal vault, descends.
The classic symptom
Plus pressure or heaviness, and sometimes difficulty emptying the bladder or bowel. As with so much in gynaecology, how bad it looks doesn't always match how bad it feels.
Older grades and the modern system
Traditional teaching grades uterine prolapse first / second / third degree (the worst, complete, is procidentia). Modern practice measures it precisely with a system called POP‑Q, using the hymen as the zero point (above = negative, beyond = positive). Know that both languages exist.
How it's helped
Options, from gentle to definitive:
- Lifestyle — treat constipation, cough; manage weight;
- Pelvic‑floor muscle training — strengthening the hammock;
- A pessary — a supportive device placed in the vagina, great for avoiding surgery;
- Surgery — tailored to the compartment(s) that failed.
(One safety note: synthetic mesh for prolapse has caused serious complications and is now tightly restricted — it is not a routine choice.) 🚩
Why it matters
Prolapse is common and quality‑of‑life‑limiting, but very treatable. Matching the fix to the woman's symptoms and wishes is the essence of kind, sensible care.
Quick check ✅
- A bulge from the front wall involving the bladder is called what?
- What's the guiding principle — do we treat the anatomy or the patient?
Remember this 🌟
Where we're going next → From structure to invaders — the infections that use these very passages. Concept 26.