Pelvic organ prolapse is the descent of pelvic structures into the vagina due to ligament or muscular weakness. Pelvic organ prolapse (POP) is subcategorized according to the compartment of descent. Cystocele characterizes anterior wall herniation, rectocele refers to the posterior vaginal wall descent, and vaginal vault prolapse characterizes descent of the uterus, cervix, or apex of the vagina. They can occur either singly or in combination. Although the etiology of POP is multifactorial, there is a high correlation with pregnancy and vaginal delivery, which can lead to direct pelvic floor muscle and connective tissue injury.

Pelvic organ prolapse is the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus (cervix), or the apex of the vagina (vaginal vault or cuff scar after hysterectomy). Prevalence increases with age. The

Types of Pelvic Organ Prolapse

  • Anterior vaginal wall prolapse
    • Cystocele (bladder into vagina)
    • Urethrocele (urethra into vagina)
    • Cystourethrocele (both bladder and urethra)
  • Posterior vaginal wall prolapse
    • Enterocele (small intestine into vagina)
    • Rectocele (rectum into vagina)
    • Sigmoidocele
  • Apical vaginal prolapse
    • Uterine prolapse (uterus into vagina)[rx]
    • Vaginal vault prolapse (roof of vagina) – after hysterectomy
  • Dropped bladder (called a cystocele). This is the most common type of pelvic organ prolapse. This happens when the bladder drops into or out of the vagina.
  • Rectocele. This happens when the rectum bulges into or out of the vagina.
  • Dropped uterus (uterine prolapse). This happens when the uterus bulges into or out of the vagina. Uterine prolapse is sometimes associated with small bowel prolapse (called enterocele), where part of the small intestine, or small bowel, bulges into the vagina.

Grading

Pelvic organ prolapses are graded either via the Baden–Walker System, Shaw’s System, or the Pelvic Organ Prolapse Quantification (POP-Q) System.[rx]

Shaw’s System

Anterior wall

  • Upper 2/3 cystocele
  • Lower 1/3 urethrocele

Posterior wall

  • Upper 1/3 enterocele
  • Middle 1/3 rectocele
  • Lower 1/3 deficient perenium

Uterine prolapse

  • Grade 0 Normal position
  • Grade 1 descent into vagina not reaching introitus
  • Grade 2 descent up to the introitus
  • Grade 3 descent outside the introitus
  • Grade 4 Procidentia

There are four general stages of severity, defined by how far the bladder, womb or bowel have dropped down:

  • First-degree prolapse: The organs have only slipped down a little.
  • Second-degree prolapse: The organs have slipped down to the level of the vaginal opening.
  • Third-degree prolapse: The vagina or womb has dropped down so much that up to 1 cm of it is bulging out of the vaginal opening.
  • Fourth-degree prolapse: More than 1 cm of the vagina or womb is bulging out of the vaginal opening.

Most women only have a mild prolapse that may even go away again after a few months or years. But it might gradually get worse over time.

Baden–Walker

Baden–Walker System[rx] for the Evaluation of Pelvic Organ Prolapse on Physical Examination
Grade Posterior urethral descent, lowest part other sites
0 normal position for each respective site
1 descent halfway to the hymen
2 descent to the hymen
3 descent halfway past the hymen
4 maximum possible descent for each site

POP-Q

POP-Q points
Pelvic Organ Prolapse Quantification System (POP-Q)
Stage Description
0 No prolapse anterior and posterior points are all −3 cm, and C or D is between −TVL and −(TVL−2) cm.
1 The criteria for stage 0 are not met, and the most distal prolapse is more than 1 cm above the level of the hymen (less than −1 cm).
2 The most distal prolapse is between 1 cm above and 1 cm below the hymen (at least one point is −1, 0, or +1).
3 The most distal prolapse is more than 1 cm below the hymen but no further than 2 cm less than TVL.
4 Represents complete procidentia or vault eversion; the most distal prolapse protrudes to at least (TVL−2) cm.

Causes of Pelvic Organ Prolapse

Pelvic organ prolapse happens when the muscles or connective tissues of the pelvis do not work as they should. The most common risk factors are:

  • Vaginal childbirth – which can stretch and strain the pelvic floor. Multiple vaginal childbirths raise your risk for pelvic organ prolapse later in life. But you can get prolapse even if you have never had children or if you had a cesarean, or C-section, delivery.
  • Long-term pressure on your abdomen – including pressure from obesity, chronic coughing, or straining often during bowel movements
  • Giving birth to a baby weighing more than 8½ pounds
  • Aging – Pelvic floor disorders are more common in older women. About 37% of women with pelvic floor disorders are 60 to 79 years of age, and about half are 80 or older.
  • Hormonal changes during menopause – Loss of the female hormone estrogen during and after menopause can raise your risk for pelvic organ prolapse. Researchers are not sure exactly why this happens.
  • Family history – Researchers are studying how genetics can play a role in pelvic organ prolapse.
  • Difficult labor and delivery or trauma during childbirth
  • Delivery of a large baby
  • Being overweight or obese
  • Lower estrogen level after menopause
  • Chronic constipation or straining with bowel movements
  • Chronic cough or bronchitis
  • Repeated heavy lifting

Symptoms of Pelvic Organ Prolapse

Mild cases of pelvic organ prolapse often don’t cause any symptoms. But if the organs drop down further, the following problems may arise:

  • feeling like something is pushing down
  • feeling like there’s a foreign object in your abdomen
  • a weak bladder, needing to urinate (pee) often, or difficulties urinating
  • a “dragging” pain in the abdomen
  • pain during sex
  • problems with bowel movements
  • The feeling of pelvic pressure or fullness
  • The bulge in the vagina
  • Organs bulging out of the vagina
  • Leakage of urine ()
  • Difficulty completely emptying the bladder
  • Problems having a bowel movement
  • Lower back pain
  • Problems with inserting tampons or applicators
  • pressure sores and bleeding in the vagina
  • a feeling of heaviness around your lower tummy and genitals
  • a dragging discomfort inside your vagina
  • feeling like there’s something coming down into your vagina – it may feel like sitting on a small ball
  • feeling or seeing a bulge or lump in or coming out of your vagina
  • discomfort or numbness during sex
  • problems peeing – such as feeling like your bladder is not emptying fully, needing to go to the toilet more often, or leaking a small amount of pee when you cough, sneeze or exercise (stress incontinence)

Pain, pressure and the feeling that there’s something inside you mainly occur when walking, standing or during bowel movements. They often go away when you lie down. If the vagina and womb bulge out of the vaginal opening and can be seen from the outside, it’s usually particularly distressing. That greatly affects your sex life too. Many women who have a severe prolapse feel ashamed and it can take an emotional toll on them.

Diagnosis of Pelvic Organ Prolapse

  • Plain Films – Plain films are usually not appropriate for the evaluation of pelvic prolapse. Barium defecography is in use at some places as a part of the assessment of pelvic floor dysfunctions, however, with the advent of newer and non-ionizing radiation imaging techniques like MR defecography, barium defecography has become largely obsolete.
  • Computed Tomography – Due to concern for radiation exposure and availability of MRI, which provides a better soft-tissue resolution, computed tomography (CT) is usually not appropriate for the evaluation of pelvic prolapse; however, one should look on the sagittal abdomen and pelvis images for a hint of pelvic floor prolapse by drawing a pubococcygeal line and see for overt prolapse and then recommend a dynamic MRI pelvis (MR Defecogram) for further evaluation.
  • Magnetic Resonance – Dynamic magnetic resonance imaging (MRI) provides an accurate assessment of pelvic prolapse. MRI provides a better anatomic detail compared to the transtibial ultrasound and is also useful as a preoperative tool. Furthermore, the MRI examination does not require bowel preparation and does not involve sensitive pelvic exposure. Despite its benefits, the MRI is not widely available, expensive, and contraindicated in patients with MRI incompatible devices or hardware.
  • Ultrasonography – Translabial ultrasound is a relatively inexpensive way of evaluating pelvic prolapse and is widely available. Besides, the ultrasound does not produce ionizing radiation and allows dynamic evaluation of the pelvic floor. However, the diagnostic quality of the ultrasound exam depends on the sonographer’s skill level and the interpreting radiologist’s familiarity with the examination.
  • Nuclear Medicine – Nuclear medicine studies are usually not appropriate for the evaluation of pelvic prolapse.
  • Angiography – Angiography is usually not appropriate for the evaluation of pelvic prolapse.
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Treatment of Pelvic Organ Prolapse

If you do not have any symptoms, or the prolapse is mild and not bothering you, you may not need medical treatment.

But making some lifestyle changes will probably still help.

These include:

  • Losing weight if you’re overweight
  • Avoiding heavy lifting
  • Preventing or treating constipation
  • vaginal pessaries – A pessary is a removable device inserted into the vagina to support the pelvic organs. Pessaries come in many different shapes and sizes. Pessaries are often the first treatment your doctor will try. Certain types of pessaries can treat both pelvic organ prolapse and urinary incontinence. A device made of rubber (latex) or silicone is inserted into the vagina and left in place to support the vaginal walls and pelvic organs. Vaginal pessaries allow you to get pregnant in the future. They can be used to ease the symptoms of moderate or severe prolapses and are a good option if you cannot or would prefer not to have surgery. Vaginal pessaries come in different shapes and sizes depending on your need. The most common is called a ring pessary.
  • Pelvic floor muscle therapy – Your doctor may show you how to do pelvic floor exercises or refer you to a physical therapist to do exercises to help strengthen the pelvic floor muscles. Pelvic floor muscle exercises can also help women who have pelvic organ prolapse as well as urinary incontinence.
  • Changing eating habits – If you have bowel problems, your doctor may recommend eating more foods with fiber. Fiber helps prevent constipation and straining during bowel movements.
  • Pelvic floor exercises – Doing pelvic floor exercises will strengthen your pelvic floor muscles and may well relieve your symptoms. A GP or specialist may recommend a program of supervised pelvic floor muscle training for at least 16 weeks before you move on to other treatments or surgery.
  • Rubber or silicone rubber device – fitted to the patient which is inserted into the vagina and maybe retained for up to several months. Pessaries are a good choice of treatment for women who wish to maintain fertility, are poor surgical candidates, or who may not be able to attend physical therapy.[rx] Pessaries require a provider to fit the device, but most can be removed, cleaned, and replaced by the woman herself. Pessaries should be offered to women considering surgery as a non-surgical alternative.
  • Osteogen Therapy – If you have a mild prolapse and have been through menopause, your doctor may recommend treatment with estrogen to ease some of your symptoms, such as vaginal dryness or discomfort during sex. Oestrogen is available as:
    • a cream you apply to your vagina
    • a tablet you insert into your vagina
    • an estrogen-releasing vaginal ringHormone (estrogen) treatment


SURGICAL TREATMENT

While reconstructive surgery for POP is an option, it must be noted that there is a 30% recurrence rate for women choosing this route. Prolapse repairs can be done transvaginally, abdominally, laparoscopically, and/or robotically (when a scope is placed through the belly button). Ultimately, the purpose of the surgery is to correct the anatomy as well as provide better bowel, bladder, and vaginal function.

  • Cystocele Repair – This surgery repairs a prolapsed bladder or urethra (urethrocele)
  • Hysterectomy – This is a complete removal of the uterus.
  • Rectocele Repair – A rectocele repairs the fallen rectum and small bowel (enterocele).
  • Vaginal Vault Suspension – Most commonly a laparoscopic procedure to repair the vaginal wall
  • Vaginal Obliteration – Closure of the vagina
    Fixation or suspension – using your own tissues (uterosacral suspension and sacrospinous fixation)—Also called “native tissue repair,” this is used to treat uterine or prolapse. It is performed through the vagina. The prolapsed part is attached with stitches to a ligament or to a muscle in the pelvis. A procedure to prevent urinary incontinence may be done at the same time.
  • —Used to treat prolapse of the anterior (front) wall of the vagina and prolapse of the posterior (back) wall of the vagina. This type of surgery is performed through the vagina. Stitches are used to strengthen the vagina so that it once again supports the bladder or the rectum.
  • —Used to treat vaginal vault prolapse and enterocele. It can be done with an abdominal incision or with laparoscopy. Surgical mesh is attached to the front and back walls of the vagina and then to the sacrum (tail bone). This lifts the vagina back into place.
  • —Used to treat uterine prolapse when a woman does not want a . Surgical mesh is attached to the and then to the sacrum, lifting the uterus back into place.
  • Surgery using vaginally placed mesh—Used to treat all types of prolapse. Can be used in women whose own tissues are not strong enough for native tissue repair. Vaginally placed mesh has a significant risk of severe complications, including mesh erosion, pain, infection, and bladder or bowel injury. This type of surgery should be reserved for women in whom the benefits may justify the risks.

Physiotherapy

Physical therapists play a major role in the nonsurgical management of POP. Along with pessary support, pelvic-floor muscle training (PFMT) is cited in highly credible reviews as a main nonsurgical option for women with POP.

For all the information re retraining, these muscles see the physiotherapy section of Pelvic Floor Dysfunction and Kegel’s Exercises

In a study by Panman et al in 2016, examining the two-year effects of pelvic floor muscle retraining, it was demonstrated that in women aged 55 and greater with symptomatic mild pelvic organ prolapse, pelvic floor muscle retraining results in a significant decrease in pelvic floor symptoms when compared to watchful waiting (note: statistically significant but below the minimal clinically important difference). Additionally, it was found that pelvic floor muscle retraining was more effective in women who experienced increased pelvic floor symptom distress at baseline. Conversely, the same study found no difference in sexual functioning, quality of life, the function of the pelvic floor muscles or degree of prolapse.

A randomized control trial compared the effect of intravaginal vibratory stimulation (IVVS) with intravaginal electrical stimulation (IVES) in women with pelvic floor dysfunctions, unable to voluntarily contract the pelvic floor muscles. The results showed improvement with both techniques, with IVVS superior to IVES in improving pelvic floor muscle strength.

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Pelvic floor muscle retraining included: (Kegel exercises diagram in illustration)

  • Explanation and description of the pelvic floor 
  • Instruction regarding how to contract and relax pelvic floor muscles 
    • If unable to perform this task, use feedback through digital palpation 
    • If insufficient control demonstrated, use my feedback or electrical stimulation 
  • General exercise program provided, subsequently modified for individual needs 
  • Taught correct technique for contracting pelvic floor muscles before and during increases in abdominal pressure 
  • Received information about washroom habits and lifestyle [rx]
  • If pelvic floor muscles were overactive, the focus was on relaxation rather than contraction 
  • Face-to-face contact with a physiotherapist as well as encouragement to maintain practice at home 3-5 times per week, 2-3 times per day.


SURGERY FOR APICAL VAGINAL PROLAPSE

Apical prolapse surgeries can broadly be separated into obliterative and restorative approaches. Restorative approaches can be performed transvaginally or abdominally. For patients desiring restorative outcomes, abdominal sacrocolpopexy remains the gold standard. Abdominal sacrocolpopexy can be performed via laparotomy, conventional laparoscopic sacrocolpopexy (LSC), or robot assisted-laparoscopic sacrocolpopexy (RSC). In a recent Cochrane review [], sacrocolpopexy including open or laparoscopic approaches were associated with lower risk of awareness of prolapse (RR, 2.11; 95% CI, 1.06–4.21), recurrent prolapse (RR, 2.28; 95% CI, 1.20–4.32), repeat surgery for prolapse (RR, 1.89; 95% CI, 1.33–2.70), postoperative stress urinary incontinence (RR, 1.86; 95% CI, 1.17–2.94) and dyspareunia (RR, 2.53; 95% CI, 1.173–5.50) than a variety of vaginal approaches.

Laparoscopic/robotic sacrocolpopexy vs. open sacrocolpopexy

Although open sacrocolpopexy is a good treatment option for apical prolapse repair, with long-term success rates of 78% to 100%, it is associated with increased length of hospital stay, analgesic requirements, and cost compared with transvaginal procedures [,]. New surgical techniques such as LSC or RSC have been developed to overcome these limitations. Compared with open sacrocolpopexy, LSC or RSC decreases overall morbidity and has good anatomical durability [,]. Freeman et al. [] performed a randomized study comparing open sacrocolpopexy and LSC in patients with vault prolapse, and found that the methods demonstrated clinical similar recurrence rates at 1 year. In 2016, Costantini et al. [] conducted the longest randomized follow-up study (mean follow-up of 41.7 months) comparing open sacrocolpopexy and LSC, and found that both techniques are efficacious with no patients in their sample experiencing apical recurrences. The 2016 Cochrane review [] reported that there may be no difference between the results of LSC and open sacrocolpopexy for repeat surgery for prolapse (RR, 1.04; 95% CI, 0.16–6.80).

2. Sacrohysteropexy for uterine preservation

There are three options for the presence of prolapsed uterus in patients with apical prolapse: sacrohysteropexy, which fixes the uterus and vagina with a mesh to the sacral promontory, thereby preserving the uterus; supracervical hysterectomy with sacrocervicocolopopexy, which does not preserve the uterus; and sacrocolpopexy after total hysterectomy with the closure of the vaginal cuff. Hysteropexy has the advantage of maintaining fertility and natural menopausal timing by preserving the uterus, and 36% to 60% of female patients choose uterine preservation assuming equal surgical efficacy. In addition, removal of the uterus may result in disruption of the uterosacral-cardinal ligaments and further weaken vaginal support. If there is no contraindication for uterine preservation, sacrohysteropexy may offer benefits. However, there is less surgical outcome data available for sacrohysteropexy, and the procedure requires continuous surveillance of the cervix and endometrium.

1) Sacrohysteropexy vs. total hysterectomy and sacrocolpopexy

There are no randomized trials comparing hysteropexy to hysterectomy and concurrent sacrocolpopexy. Costantini et al. [] conducted prospective studies comparing abdominal sacrohysteropexy to total hysterectomy and sacrocolpopexy. In this study, 72 patients with grade 3 to 4 POP self-selected to undergo either sacrohysteropexy or total hysterectomy and sacrocolpopexy. Both groups demonstrated similar, good success rates (100% and 100%) with no reoperations due to recurrence. The sacrohysteropexy group experienced a shorter average operation time (89 vs. 115 minutes) and greater improvement in sexual function when compared to the total hysterectomy and sacrocolpopexy group.

Based on current knowledge, there are significantly higher reoperation rates for POP in patients treated with hysteropexy, while the mesh exposure rate is 3.5-fold higher after sacrocolpopexy among patients treated with a concomitant total hysterectomy. It is difficult to determine whether sacrohysteropexy and total hysterectomy and sacrocolpopexy results in superior outcomes given our current knowledge [,].

2) Supracervical hysterectomy and sacrocolpopexy

The benefits of supracervical hysterectomy may reduce the risk of mesh erosion, thus avoiding cautery-induced thermal injury to the vagina []. Warner et al. [] observed a 4.9% mesh exposure rate for the total hysterectomy group, but no mesh exposures were seen in the supracervical hysterectomy group (p=0.03). However, evidence for the efficacy of supracervical hysterectomy is still lacking. A small study comparing laparoscopic sacrohysteropexy (n=15) to laparoscopic sacrocolpopexy with concomitant supracervical hysterectomy showed that the overall success rate was significantly higher for laparoscopic supracervical hysterectomy with sacrocolpopexy (67% vs. 27%), but major complications and vaginal mesh erosions were not registered []. A retrospective study demonstrated that supracervical hysterectomy with sacrocolpopexy was 2.8 times more likely to result in recurrent prolapse than total hysterectomy with sacrocolpopexy when recurrent prolapse was defined as prolapse greater than or equal to stage 2. This study did not have sufficient power to detect differences in rates of mesh exposure, with 7.5% in the total hysterectomy with sacrocolpopexy group vs. 2.3% in the supracervical hysterectomy with sacrocolpopexy group (p=0.35) [].

3. Mesh fixation techniques

In an effort to decrease the morbidity associated with open sacrocolpopexy, RSC, which decreases the difficulty associated with laparoscopic knot tying, and 3-dimensional visualization aiding sacral dissection, has rapidly gained popularity. However, variation in surgical technique includes the amount of vaginal dissection, type of mesh, number or location of sutures that should be placed to secure the suspending mesh, retroperitonealization of the mesh, and cervix preservation [,].

1) Absorbable vs. non-absorbable suture

Traditional open sacrocolpopexy uses nonabsorbable suture to prevent the mesh from detaching from the vagina and sacral promontory and to decrease the risk of mesh exposure and suture erosion. After synthetic mesh implantation, porcine models showed that 74% of the final strength of tissue ingrowth into mesh is achieved by 2 weeks, and maximum strength is reached by 3 months. Delayed absorbable monofilament suture lost 50% of its tensile strength by 4 weeks, 100% by 2 to 3 months, and was completely absorbed by 6 to 8 months []. In terms of risk of mesh complications, the mesh/suture exposure rate was 3.7% (6/161) for braided non-absorbable suture (2-0 Ethibond; Ethicon, Somerville, NJ, USA) while no erosions occurred with monofilament delayed-absorbable suture (2-0 polydioxanone suture, Ethicon) (p=0.002) []. In a series of RSC patients with a median 33 months follow-up, the use of absorbable sutures for both vaginal and sacral mesh attachment was effective, with a 3-year rate of survival without repeat prolapse surgery of 93%. However, in this study, the benefit of risk of mesh erosion was not assessed []. Although evidence is lacking, it is unlikely that absorbable sutures are a risk factor for mesh detachment. Further studies will be needed to determine the proper location of sutures and the number of sutures, as well as the best type of suture to use in POP repair.

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2) Barbed suture

The most challenging procedure during LSC or RSC is the attachment of the polypropylene mesh to the anterior and posterior vaginal walls and retroperitonealization over the mesh, which can be time-consuming. In LSC, suturing and knot tying are related to steeper learning curves compared to RSC [,,]. To overcome this step, the use of barbed sutures has been described in several studies. Tan-Kim et al. [] conducted a randomized study comparing non-barbed interrupted sutures to barbed suture (Quill™) for anchoring the mesh to the vaginal wall during LSC or RSC. Among all patients, those treated with non-barbed suture had significantly longer operation times than those treated with barbed suture (42 vs. 29 minutes, p<0.001) and there were no significant differences in anatomic failure between the groups at 12 months. Another retrospective study reported 1-year outcomes in 20 patients who underwent RSC using barbed delayed absorbable sutures (3-0 V-Loc 180, Covidien, Dublin, Ireland). The barbed delayed absorbable suture was used only for fixing the mesh to the vagina wall and performing retroperitonealization. There was no recurrence of apical prolapse or mesh exposure at 1-year follow-up []. Kallidonis et al. [] also demonstrated that using barbed sutures for mesh fixation and peritoneal closure during LSC was safe and associated with reduced operating time. It is believed that the use of barbed suture plays reduces operation time by facilitating retroperitonealization of mesh. However, further studies should be performed for elucidating the ideal role of barbed suture for securing the mesh to the vaginal wall.

4. Single port approach

Single port approaches herald a new era in the field of minimally invasive surgery, with good cosmetic results and reduced patient morbidity compared with multiport surgery. Although single-port robotic surgery is in an early stage of development, it has been implemented in various surgical fields. Since 2017, a few reports describing single port RSC have demonstrated that it is a feasible technique [,,,]. In 2017, Matanes et al. [] reported their first 25 experiences with single port RSC and demonstrated significant decreases in median total operative and console times (226 minutes for the first 15 cases vs. 156 minutes for the next 10 cases), decreases that were within the same range as that reported for initial experiences with multiport access. There were no intraoperative adverse events. There was 1 case of small bowel obstruction that required reoperation, but this patient did not achieve retroperitonealized over the mesh, which altered the surgeon’s approach toward all subsequent patients. Recently, Liu et al. [] published a case series of patients treated with single port RSC following a modified technique. They attempted retroperitoneal tunneling techniques and asserted that they could more easily perform these techniques via a single port approach. A retroperitoneal tunnel was created by undermining the peritoneum with an articulated needle driver. The needle driver was placed in the peritoneal opening over the sacral promontory, and the tunnel was created just medial to the right uterosacral ligament in the direction of the vaginal vault by using forward pressure and a sweeping motion to create a space within the retroperitoneum. This approach allowed for easier adjustment and maintenance of mesh tension during the placement of sutures in the sacral promontory compared with opening the entire retroperitoneal space, and may reduce operative time and adhesion formation.

SURGERY FOR POSTERIOR COMPARTMENT PROLAPSE

Posterior vaginal wall prolapse can cause the sensation of bulging in the vagina and symptoms of obstructed defecation. The overall prevalence of posterior compartment prolapse alone is not certain, because it is usually accompanied by anterior or apical prolapse. As up to 80% of rectoceles are reported to be asymptomatic, its prevalence may be underestimated []. Surgical treatment of posterior compartment prolapse can be approached either transvaginally, transperineally, or transanally, and can be repaired with native tissue or using mesh. Traditionally, central and lateral defects have been repaired with plication of rectovaginal fascia (known as posterior colporrhaphy). In 2006, Paraiso et al. [] conducted a randomized study comparing outcomes of 3 different rectocele repair techniques: posterior colporrhaphy, site-specific repair, and site-specific repair augmented with a porcine small intestinal submucosal graft.

Glossary

  • Bladder: A hollow, muscular organ in which urine is stored.
  • Cervix: The lower, narrow end of the uterus at the top of the vagina.
  • Colporrhaphy: Surgery done through the vagina to repair a bulge using a woman’s own tissue.
  • Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.
  • Hysterectomy: Surgery to remove the uterus.
  • Kegel Exercises: Pelvic muscle exercises. Doing these exercises helps with bladder and bowel control as well as sexual function.
  • Laparoscopy: A surgical procedure in which a thin, lighted telescope called a laparoscope is inserted through a small incision (cut) in the abdomen. The laparoscope is used to view the pelvic organs. Other instruments can be used with it to perform surgery.
  • Ligament: A band of tissue that connects bones or supports large internal organs.
  • Obliterative Surgery: A type of surgery in which the vagina is narrowed or closed off to support organs that have dropped down.
  • Pelvic Floor: A muscular area that supports a woman’s pelvic organs.
  • Pelvic Organ Prolapse (POP): A condition in which a pelvic organ drops down. This condition is caused by weakening of the muscles and tissues that support the organs in the pelvis, including the vagina, uterus, and bladder.
  • Pessary: A device that can be inserted into the vagina to support the organs that have dropped down or to help control urine leakage.
  • Reconstructive Surgery: Surgery to repair or restore a part of the body that is injured or damaged.
  • Rectum: The last part of the digestive tract.
  • Sacrocolpopexy: A type of surgery to repair vaginal vault prolapse. The surgery attaches the vaginal vault to the sacrum with surgical mesh.
  • Sacrohysteropexy: A type of surgery to repair uterine prolapse. The surgery attaches the cervix to the sacrum with surgical mesh.
  • Sexual Intercourse: The act of the penis of the male entering the vagina of the female. Also called “having sex” or “making love.”
  • Urethra: A tube-like structure. Urine flows through this tube when it leaves the body.
  • Urinary Incontinence: Uncontrolled loss of urine.
  • Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus.
  • Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.
  • Vaginal Vault: The top of the vagina after hysterectomy (removal of the uterus).

References

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