Pelvic organ prolapse

Last updated: August 26, 2022

Summarytoggle arrow icon

Pelvic organ prolapse (POP or female genital prolapse) is the protrusion of bladder, rectum, intestines, uterus, cervix, or vaginal apex into the vaginal vault due to decreased pelvic floor support. It is commonly seen in women of advanced age. Other risk factors include multiparity (particularly vaginal births), prior pelvic surgery, connective tissue disorders, and increased intra-abdominal pressure secondary to obesity or chronic constipation. Patients present with a sensation of vaginal pressure, discomfort, and/or pain. The protruded pelvic organ is visualized and assessed during inspection. Low-grade prolapse can be managed conservatively with pelvic floor (Kegel) exercises or a vaginal pessary to support the pelvic floor. Pelvic floor repair surgery is indicated for women with symptomatic prolapse who do not respond to or decline conservative management. Complications include urinary or fecal retention or incontinence, abdominal/pelvic pain, and avoidance of sexual activity because of embarrassment or discomfort.

  • Definition: herniation into or descent of pelvic organs to or beyond the vaginal walls
    • Partial/subtotal prolapse: pelvic organs are only partially outside the vaginal opening.
    • Total prolapse: pelvic organs are everted and located outside of the vaginal opening.
  • Anatomical overview: The pelvic floor is supported by a continuous endopelvic fascia, which consists of:
  • Specific sites
    • Vaginal wall prolapse
    • Uterine prolapse: descent of the uterus
    • Vaginal vault prolapse: descent of the apex of the vagina
    • Apical compartment prolapse: herniated uterus, cervix, or vaginal vault
    • Uterine procidentia: protrusion of all vaginal walls or cervix beyond the vaginal introitus

  • POP is a common disorder in older women.

Epidemiological data refers to the US, unless otherwise specified.

Patients with POP may present with concurrent complications.

Usually, a clinical diagnosis that relies on the Pelvic Organ Prolapse Quantitation system (POP-Q): [2][3]

  • Stage 0: no prolapse
  • Stage 1: The most distal portion of prolapse is more than 1 cm above the level of the hymen.
  • Stage 2: The most distal portion of prolapse is 1 cm or less proximal or distal to the hymenal plane.
  • Stage 3: The most distal portion of prolapse is more than 1 cm from the hymenal plane but no more than 2 cm less than the vaginal length.
  • Stage 4: The vagina is completely everted or uterine procidentia has occurred.

Elongation of the cervix

Urethral diverticulum [4]

Pelvic floor dysfunction [5]

The differential diagnoses listed here are not exhaustive.

General principles [6]

Conservative treatment [2]

First-line treatment for all patients with symptomatic POP.

  • Vaginal pessary
    • A silicone or latex device that is inserted into the vagina
    • Provides support for pelvic organs
  • Kegel exercises: pelvic floor muscle training (also as a preventive measure)

Pessaries should be removed and cleaned regularly to prevent the development of vaginal pressure ulcers.

Surgery [7]

Indicated for symptomatic prolapse if conservative treatment fails or the patient prefers definitive treatment over conservative therapy.

Urinary disorders [8]

Defecation disorders

Other complications

We list the most important complications. The selection is not exhaustive.

  1. Aboseif C, Liu P. Pelvic Organ Prolapse. StatPearls. 2021 .
  2. Iglesia et al.. Pelvic Organ Prolapse. American Family Physician. 2017; 96 (3).
  3. Persu C, Chapple CR, Cauni V, Gutue S, Geavlete P. Pelvic Organ Prolapse Quantification System (POP–Q) – a new era in pelvic prolapse staging. J Med Life. 2011; 4 (1): p.75-81.
  4. Quiroz LH AND Gutman RE. Urethral diverticulum in women. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/urethral-diverticulum-in-women?search=Urethral%20diverticulum&source=search_result&selectedTitle=1~26&usage_type=default&display_rank=1#H708034.Last updated: June 4, 2020. Accessed: August 20, 2020.
  5. Grimes WR, Stratton M. Pelvic Floor Dysfunction. StatPearls. 2021 .
  6. Iglesia CB, Smithling KR. Pelvic Organ Prolapse.. American family physician. 2017; 96 (3): p.179-185.
  7. Surgery for Pelvic Organ Prolapse. https://www.acog.org/Patients/FAQs/Surgery-for-Pelvic-Organ-Prolapse#pelvic. Updated: December 1, 2013. Accessed: November 5, 2017.
  8. Jundt K, Wagner S, von Bodungen V, Friese K, Peschers U. Occult incontinence in women with pelvic organ prolapse - does it matter?. Eur J Med Res. 2010; 15 (3): p.112. doi: 10.1186/2047-783x-15-3-112 . | Open in Read by QxMD
  9. Archer R, Blackman J, Stott M, Barrington J. Urethral diverticulum. The Obstetrician & Gynaecologist. 2015; 17 (2): p.125-129. doi: 10.1111/tog.12192 . | Open in Read by QxMD

3 free articles remaining

You have 3 free member-only articles left this month. Sign up and get unlimited access.
 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer