Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 18-07: Pelvic Organ Prolapse + Key Features Download Section PDF Listen +++ ++ Vaginal hernias commonly seen in multiparous women Cystocele Rectocele Enterocele Cystocele is a hernia of the bladder wall into the vagina, causing a soft anterior fullness Cystocele may be accompanied by urethrocele, which is not a hernia but a sagging of the urethra after its detachment from the pubic symphysis during childbirth Rectocele is a herniation of the terminal rectum into the posterior vagina, causing a collapsible pouch-like fullness Enterocele is a vaginal vault hernia containing small intestine, usually in the posterior vagina and resulting from a deepening of the pouch of Douglas All three types of hernia may occur in combination Risk factors for pelvic organ prolapse may include Vaginal birth, with injury to pelvic floor Genetic predisposition Advancing age Prior pelvic surgery Connective tissue disorders Increased intra-abdominal pressure associated with obesity or straining associated with chronic constipation or coughing + Clinical Findings Download Section PDF Listen +++ ++ Sensation or observation of a bulge or protrusion in the vagina Urinary or fecal incontinence Constipation A sense of incomplete bladder emptying Dyspareunia + Diagnosis Download Section PDF Listen +++ ++ Clinical: pelvic examination + Treatment Download Section PDF Listen +++ ++ Supportive measures High-fiber diet and laxatives to improve constipation Weight reduction in obese patients Limitation of straining and lifting are helpful Pelvic muscle training (Kegel exercises) is a simple, noninvasive intervention that may improve pelvic function The only cure for symptomatic cystocele, rectocele, or enterocele is corrective surgery Pessaries, which may reduce a cystocele, rectocele, or enterocele, are helpful in women who do not wish to undergo surgery or who are poor surgical candidates For uterine prolapse, the type of surgery depends on extent of prolapse and the desire for menstruation, pregnancy, and coitus The simplest, most effective procedure is vaginal hysterectomy with repair of the cystocele, rectocele or enterocele as needed If pregnancy is desired, a partial resection of the cervix with plication of the cardinal ligaments can be attempted For older women who do not desire coitus, partial obliteration of the vagina is surgically simple and effective Uterine suspension with sacrospinous cervicocolpopexy may be an effective approach in older women who wish to avoid hysterectomy but preserve coital function