POP is the phenomenon of ‘loss of support of the pelvic organs (uterus, vagina, bladder, rectum) with subsequent “Falling” or “Bulging out” of the organs (as a result of upright posture).
Types of POP

  • Anterior compartment prolapse = cystocele
  • Posterior compartment prolapse = rectocele / enterocele
  • Middle compartment prolapse = uterus / vault prolapse (no uterus)

Symptoms

Depends on the site and severity of prolapse. Usually better when lying down or in the morning, worse when standing or in the later of the day.

  • Common symptoms include:
    • Lump in vagina/ introitus
    • Feeling of “heaviness”
    • Low back pain
    • Difficulty in coitus

Causes of pelvic organ prolapse

Exact reason unknown. The followings may predispose to prolapse:

  • Pregnancy & childbirth, e.g. multiparity, long labour, traumatic delivery
  • Aging & weaken muscles, decrease in elasticity of ligaments, atrophic muscles
  • Post menopausal: Due to hormone deficiency, speed up atrophy
  • Post surgery, e.g. previous hysterectomy with poor support from vaginal vault, continence surgery
  • Chronic increase in intra-abdominal pressure, e.g. obesity, heavy lifting, chronic cough and constipation, etc

Treatment of POP

Depends on the symptoms and severity. Mild asymptomatic prolapse does not need treatment, although they might get worse with age. Asymptomatic prolapse can be treatment by non-surgical or surgical means.

Non-surgical
PVC / Silicone ring pessary

  • Provide temporary relief
  • Need to come change the pessary regularly
  • Can lead to ulceration if prolong use and sexual problem

Pelvic floor reconstruction surgery

  • Restore normal position of pelvic organs
  • Restore sexual function
  • Restore normal urinary and bowel functions

Types of surgeries:

Vaginal route:

  • Vaginal hysterectomy
  • Anterior & posterior pelvic floor repair
  • Vaginal mesh repair
  • Sacrospinous fixation
  • Manchester operation
  • Colpoclesis

Abdominal / laparoscopic

  • Sacrocolpopexy