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Overview of Pelvic Organ Prolapse (POP) Anterior and Posterior Vaginal Wall Prolapse Which of the following symptoms of premenstrual dysphoric disorder most likely differentiates this disorder from premenstrual syndrome? , MD, MEd, Baylor College of Medicine Last full review/revision Jan 2021| Content last modified Jan 2021 Uterine prolapse is descent of the uterus toward or past the introitus . Apical prolapse is descent of the vaginal vault or vaginal cuff after hysterectomy . Symptoms include vaginal pressure and fullness . Diagnosis is clinical . Treatment includes reduction, pessaries, and surgery . Severity of these disorders can be graded by the Baden-Walker system which is based on level of protrusion: Although the Baden-Walker system is sometimes used, it is an older classification system, that is not reproducible; thus, professional organizations recommend the Pelvic Organ Prolapse-Quantification (POP-Q) system . The POP -Q system is a more reliable and reproducible classification system that is based on predefined anatomic landmarks: Stage I: Most distal prolapse is more than 1 cm above the hymen Stage II: Most distal prolapse is between 1 cm above and 1 cm below the hymen Stage III: Most distal prolapse is more than 1 cm below hymen but 2 cm shorter than total vaginal length Symptoms tend to be minimal with 1st-degree uterine prolapse . In 2nd- or 3rd-degree uterine prolapse, fullness, pressure, dyspareunia, and a sensation of organs falling out are common; the most common presenting symptom is a vaginal bulge . Lower back pain may develop . Incomplete emptying of the bladder and constipation are possible . Third-degree uterine prolapse manifests as a bulge or protrusion of the cervix or vaginal cuff, although spontaneous reduction may occur before patients present . Vaginal mucosa may become dried, thickened, chronically inflamed, secondarily infected, and ulcerated . Ulcers may be painful or bleed and occasionally resemble vaginal cancer . The cervix, if protruding, may also become ulcerated . DR P . MARAZZI/SCIENCE PHOTO LIBRARY Symptoms of vaginal prolapse are similar . Cystocele or rectocele is usually present . Urinary incontinence is common . The descending pelvic organs may intermittently obstruct urine flow, causing urinary retention and overflow incontinence and masking stress incontinence . Urinary frequency and urge incontinence may accompany uterine or vaginal prolapse . Diagnosis of uterine or vaginal prolapse is confirmed by speculum or bimanual pelvic examination . Rarely, vaginal ulcers require a biopsy to exclude cancer . Simultaneous urinary incontinence requires evaluation . For mild symptomatic prolapse, pessaries Surgical repair of supporting structures if necessary, usually with hysterectomy Asymptomatic prolapse does not require treatment, but patients should be followed clinically for progression . Symptomatic prolapse can be treated with a pessary if the perineum can structurally support a pessary; surgical repair is an option for women who do not wish to use a pessary or the perineum cannot support a pessary . Surgery for uterovaginal prolapse can be done through the vagina or through an incision in the abdomen using various techniques . Factors determining choice of techniques include surgeon experience and patient desires . Techniques may include one or a combination of the following: Surgical repair of the pelvic support structures (colporrhaphy) Suspension of the top of the vagina (suturing of the upper vagina to a stable structure nearby) Colpocleisis (closure of the vagina after removal of the uterus or with the uterus in place [Le Fort procedure]) In general, vaginal surgery causes less morbidity and a more rapid recovery time than abdominal surgery . Regardless of the surgical route, symptoms often recur, especially along the anterior vaginal wall . Surgery is delayed until all ulcers, if present, have healed . Vaginal prolapse is treated similarly to uterine prolapse . The vagina may
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