The urogenital diaphragm is a muscular structure that supports the pelvic organs and plays a role in urinary and reproductive functions.
The PISQ assesses the impact of pelvic organ prolapse and urinary incontinence on sexual function and quality of life.
A pessary is a device inserted into the vagina to support pelvic organs and manage conditions like pelvic organ prolapse.
Vaginal erosion can be treated by removal of the pessary and optional vaginal estrogen supplementation.
Kegel exercises are also known as pelvic floor muscle training.
Flexible pessary designs allow women to use and remove the pessary themselves as desired.
Many women with advanced prolapse, particularly involving the anterior vagina, will not have symptoms of urinary incontinence.
Less than half of women discuss symptoms with their primary care provider (PCP).
Kegel exercises are exercises designed to strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine, and rectum.
The uterosacral ligaments are fibrous bands that connect the uterus to the sacrum, providing support and stability to the uterus.
The apex of the vagina refers to the uppermost part of the vaginal canal, which can descend or prolapse due to weakened pelvic support structures.
Enterocele is a type of prolapse where the small bowel descends into the upper wall of the vagina, often occurring in conjunction with other pelvic organ prolapses.
Patients should have a follow-up visit in one to two months, and then every 12 months thereafter.
Tools used include a Sims retractor (single blade speculum) or a bivalve speculum that can be taken apart to observe individual compartments of the vagina (anterior, posterior, apical).
The scale that describes the prolapse in relationship to the vaginal hymen is known as the Pelvic Organ Prolapse Quantification (POP-Q) system.
A rectocele is a posterior wall defect that occurs when the pressure from the rectum forces the posterior vaginal wall in an upward direction due to loss of lateral support.
A comprehensive physical examination includes the evaluation of specific anatomic sites with measurements that define the severity of prolapse, focusing on landmarks such as the urethra, vagina, perineum, and anal sphincter.
Physical impairment refers to limitations in mobility, dexterity, or visual acuity that may affect the management of Pelvic Organ Prolapse.
Severity of symptoms does not correlate well with the stage of prolapse; symptoms are often related to position and can worsen as the day progresses or with activity.
Expectant management is an acceptable treatment option for patients without evidence of urinary or bowel obstruction, taking into account the type and severity of symptoms, patient’s age, other comorbid conditions, sexual function, infertility, and risk of recurrence.
The endopelvic fascia is a connective tissue layer that provides support to the pelvic organs and helps maintain their position within the pelvis.
Vault prolapse occurs when the vaginal cuff, which is the remnant of the vagina after a hysterectomy, descends or protrudes due to loss of support.
Advanced anterior or apical prolapse may kink the urethra, resulting in obstructed voiding symptoms such as a slow urine stream, the need to change position to urinate, a sensation of incomplete emptying, and in rare cases, complete urinary retention.
A pessary is a device that provides mechanical or physical support to hold up prolapsed tissues within the vagina.
The distinction between symptomatic and asymptomatic POP is clinically relevant, as treatment is generally indicated only for women with symptoms.
Some women may become incontinent after prolapse surgery.
Stress incontinence is a condition where women may experience involuntary leakage of urine during activities that increase abdominal pressure, and it can occur even when pelvic support is detected on examination.
Loss of support for the uterus can lead to varying degrees of uterine prolapse.
Pessaries designed to stay in place are fitted for a specified time before being changed by a specialist.
Injury to the levator ani or local nerves, particularly the pudendal nerve, can contribute to the development of pelvic organ prolapse by weakening the pelvic support structures.
Reconstructive procedures are done with the goal of restoration of vaginal anatomy.
Functional obstruction due to prolapse can lead to hydronephrosis or hydroureter due to obstruction of the urinary tract.
An enterocele is a condition where the small bowel drops into the space between the vagina and the rectum.
The exact prevalence of POP is difficult to ascertain due to varying classification systems, differences in reporting rates for symptomatic versus asymptomatic women, and the unknown number of women with POP who do not seek medical attention.
There are few high-quality data regarding the prevalence of symptomatic POP, making it challenging to determine.
The pessary should be removed, cleaned with soap and water, and left out overnight every one to two weeks.
Multiple organ involvement refers to the condition where more than one pelvic organ is affected by loss of support, which is the most common scenario in pelvic organ prolapse.
Vaginal discharge and odor can be treated without discontinuing pessary use.
A cystocele is an anterior wall defect that occurs when the bladder forces the anterior vaginal wall down and out.
Atrophic changes from aging or estrogen loss can lead to decreased tissue elasticity and strength, increasing the risk of pelvic organ prolapse.
New procedures using surgical mesh and graft material have higher success rates but limited follow-up or comparative data.
The pessary should be removed before sexual intercourse.
Landmarks evaluated include the urethra, vagina (anterior and posterior vaginal walls, paravaginal wall, and vaginal apex), perineum, and anal sphincter.
The purpose of Kegel exercises is to prevent or control urinary incontinence and other pelvic floor problems.
The cardinal ligaments are connective tissues that support the cervix and provide structural integrity to the pelvic organs.
Ascites is associated with increased intra-abdominal pressure, which can increase tension on the abdominal wall and weaken the abdominal fascia.
Obesity, defined as a BMI greater than 25, may increase the risk of developing pelvic organ prolapse due to elevated intra-abdominal pressure.
A survey reported that 23 percent of clinicians changed their patients’ pessaries every three to six months.
Symptoms are often less noticeable in the morning or while supine and worsen as the day progresses or when women are active in an upright position.
