RT Book, Section A1 Long, Jill A1 Shvartsman, Katerina A2 Papadakis, Maxine A. A2 McPhee, Stephen J. A2 Rabow, Michael W. A2 McQuaid, Kenneth R. SR Print(0) ID 1184751428 T1 Pelvic Organ Prolapse T2 Current Medical Diagnosis & Treatment 2022 YR 2022 FD 2022 PB McGraw-Hill Education PP New York, NY SN 9781264269389 LK accessmedicine.mhmedical.com/content.aspx?aid=1184751428 RD 2024/03/28 AB Pelvic organ prolapse, including cystocele, rectocele, and enterocele, are vaginal hernias commonly seen in multiparous women. Cystocele is a hernia of the bladder wall into the vagina, causing a soft anterior fullness (eFigure 18–7). Cystocele may be accompanied by urethrocele, which is not a hernia but a sagging of the urethra following 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 (eFigure 18–8). Enterocele is a vaginal vault hernia containing small intestine, usually in the posterior vagina and resulting from a deepening of the pouch of Douglas. Two or all three types of hernia may occur in combination. The cause of pelvic organ prolapse is multifactorial. Risk factors include vaginal birth, genetic predisposition, advancing age, prior pelvic surgery, connective tissue disorders, and increased intra-abdominal pressure associated with obesity or straining associated with chronic constipation or coughing (eFigures 18–7, 18–8, 18–9, 18–10). A woman's lifetime risk of surgery for pelvic organ prolapse is 12–19%.