1. Dr. Hazem Al-Mandeel 481 GYN Department of Obstetrics & Gynecology
PELVIC ORGAN PROLAPSE
Dr. Hazem Al-Mandeel
481 GYN
Department of Obstetrics & Gynecology

2. Objectives To define pelvic organ prolapse Recognize pelvic anatomy
Determine the Pathophysiology
Discuss the predisposing factors
Understand the grading systems
Be aware of the options of management

3. Pelvic Organ Prolapse
Is the descent of the pelvic organs as a result of the loss of muscular and fascial structural support .

4. Anatomic Supports Muscular : Levator Ani (Pelvic Floor Ms.)
Ligaments : Uterosacral-Cardinal Complex
Fascial : Endopelvic (Pubocervical & Rectovaginal)

5. Levator Ani Major structure of pelvic floor
Anterior/posterior orientation
Perforated by urogenital hiatus
Consists of : Pubococcygeus
Iliococygeus
Puborectalis
Coccygeus

8. Endopelvic Fascia Fibromuscular layer
Local condensations are ligaments
Principal ligaments are Uterosacral
Cardinal
Pubocervical and Rectovaginal Fascia important in specific surgical correction

12. Pathophysiology Direct Trauma to pelvic soft tissues
Neurological injury
Connective tissue disorders

13. Predisposing Factors Hereditary (genetic) predisposition
Race: White > Black > Asian
Pregnancy and Vaginal Childbirth
Age and Menopause
Raised intra-abdominal pressure (e.g.: obesity, cough, constipation, lifting, etc)
Iatrogenic: surgical procedure

14. Types of Pelvic Organ Prolaopse
1. Urethra
2. Bladder
3. Uterus/ Vaginal Vault
4. Small Bowel
5. Rectum
6. Perineum

15. Compartments Anterior : Cystocele Urethrocele
Middle : Uterine prolapse
Enterocele/vault prolapse
Posterior : Rectocele
Rectal prolapse

21. Classification of Prolapse
Baden Walker (1972)
Each site graded from 1 – 4
POPQ: quantifies using specific points
Measured relation to the hymenal ring
More widely used

22. Symptoms of Prolapse Pelvic pressure Pelvic pain Feeling of a “lump”
Back pain
Urinary dysfunction
Bowel dysfunction

23. Complications of Prolapse
Bleeding
Infection
Recurrent UTI’s
Urinary obstruction
Renal failure

24. Associated conditions
Urinary Incontinence : Stress
Urge
Mixed
Fecal Incontinence : sphincter injury

25. Options of Management No Treatment ( pelvic floor exercise)
Conservative: such as
Physiotherapy or Pessary
Surgical Treatment

28. Aims of prolapse surgery
Alleviate symptoms
Restore normal anatomy
Restore normal visceral function
Avoid new bladder or bowel symptoms
Preserve sexual function
Avoid surgical complications

30. Conclusions Pelvic organ prolapse is common
Results from injury to soft tissue and nerves
Childbirth most significant association
Treatment requires understanding of anatomic relationships
Treated with a combination of physio/pessary and often complex surgery