Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is a condition characterized by the descent of pelvic structures, including the anterior or posterior vaginal wall, uterus, cervix, or vaginal apex, into or beyond the vaginal canal due to weakening of the pelvic floor's supportive tissues, including muscles, fascia, and ligaments. This structural weakness allows adjacent organs, such as the bladder, rectum, or small intestine, to herniate into the vaginal space, resulting in clinical manifestations including cystocele, rectocele, enterocele, or uterine prolapse. Mild prolapse may be asymptomatic and fall within physiological limits, but POP becomes clinically significant when it causes symptoms such as pelvic pressure, a sensation or visible bulge in the vagina, difficulty with urination or defecation, urinary or fecal incontinence, or sexual dysfunction. Initial evaluation should involve a thorough clinical history and a detailed pelvic examination, with particular attention to associated complications such as urinary incontinence, bladder outlet obstruction, and fecal incontinence. Pelvic Organ Prolapse Quantification (POP-Q) staging and the Baden-Walker grading system are commonly used to assess the severity and compartmental involvement of the prolapse. The severity of prolapse, symptom burden, patient preferences, and functional goals guides management strategies. Options range from conservative measures—such as watchful waiting and vaginal pessary use—to definitive surgical correction. Surgical interventions include reconstructive procedures—performed with or without synthetic or biological graft materials—as well as obliterative procedures, which may be appropriate for select non-sexually active individuals.