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Pelvic organ prolapse is a condition of specific signs and symptoms that lead to impairment of normal function and diminished quality of life. Signs include descent of one or more of the following: the anterior vaginal wall, posterior vaginal wall, uterus and cervix, the apex of the vagina after hysterectomy, or the perineum (Haylen, 2010). Symptoms include vaginal bulging, pelvic pressure, and splinting or digitation. Splinting is manual bolstering of the prolapse to improve symptoms, whereas digitation aids stool evacuation. For pelvic organ prolapse to be considered a disease state in a given individual, symptoms should be attributable to pelvic organ descent such that surgical or nonsurgical reduction relieves the symptoms, restores function, and improves quality of life.

Pelvic organ prolapse (POP) is a health concern affecting millions of women worldwide. In the United States, it is the third most common indication for hysterectomy. Moreover, a woman has an estimated lifetime risk of 11 percent to undergo surgery for prolapse or incontinence (Olsen, 1997).

Estimation of disease prevalence has been hampered by lack of a consistent definition of pelvic organ prolapse. If the validated Pelvic Organ Prolapse Quantification (POP-Q) examination alone is used to describe pelvic organ support, 30 to 65 percent of women presenting for routine gynecologic care have stage 2 prolapse (Bland, 1999; Swift, 2000, 2005; Trowbridge, 2008). In contrast, studies that define prolapse solely based on patient symptoms show a prevalence ranging from 2.9 to 5.7 percent in the United States (Bradley, 2005; Nygaard, 2008; Rortveit, 2007).

Although data are limited, studies show that the prevalence of pelvic organ prolapse increases steadily with age (Olsen, 1997; Swift, 2005). Given the condition's link to age and the changing demographics in the United States, the prevalence of pelvic organ prolapse will undoubtedly grow.

Table 24-1 summarizes predisposing factors for pelvic organ prolapse. Researchers agree that its etiology is multifactorial and develops gradually over a span of years. The relative importance, however, of each factor is not known.

Table 24-1. Risk Factors Associated with Pelvic Organ Prolapse

Obstetric-Related Risks


Vaginal childbirth is the most frequently cited risk factor. Although there is some evidence that pregnancy itself predisposes to pelvic organ prolapse, numerous studies have clearly shown that vaginal delivery increases a woman's propensity for developing POP. For example, in the Pelvic Organ Support Study (POSST), increasing parity was associated with advancing prolapse (Swift, 2005). Specifically, the risk of POP increased 1.2 times with ...

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