Occurs when there is descent of one or more of the pelvic organs including the uterus, bladder, rectum, small or large bowel, or vaginal vault

Aetiology

Risk factors

• Sex - women are more likely than men to have pelvic organ prolapse
  • Pregnancy, childbirth, giving birth to a large baby and menopause are risk factors which are exclusive to women
• Increasing age
• Obesity - being overweight increases the pressure on the pelvic floor
• Smoking - a chronic cough can cause episodes of high pressure in the abdomen or aggravate prolapse that has other causes
• Being Hispanic, Indian or White
• Prior pelvic surgery
• Others: heavy lifting, constipation, COPD, hereditary causes (family history of weakness in connective tissue e.g. Marfan's, Ehrlers-Danlos)

Pathophysiology

• The pelvic organs are normally supported by the levator ani muscles and the endopelvic fascia

Types of genitourinary prolapse

Anterior compartment prolapse

• Urethrocele: prolapse of the urethra into the vagina, frequently associated with urinary stress incontinence
• Cystocele: prolapse of the bladder into the vagina
• Cystourethrocele: prolapse of both urethra and bladder

Middle compartment prolapse

• Uterine prolapse: descent of the uterus into the vagina
• Vaginal vault prolapse: descent of the vaginal vault in post-hysterectomy
  • Often associated with cystocele, rectocele and enterocele