Pelvic Organ Prolapse

What is pelvic organ prolapse?

Pelvic organ prolapse occurs when the support structures of the pelvic floor — muscles, ligaments and fascia — weaken over time, allowing one or more pelvic organs to bulge into the vagina. The condition affects approximately 30–40% of parous women at some point. POP is not a single condition but a spectrum, often involving multiple compartments simultaneously: anterior (cystocele), posterior (rectocele, enterocele), apical (uterine descent, vaginal vault prolapse) and combined defects. Symptoms range from a sense of pelvic heaviness to a visible vaginal bulge, urinary leakage or retention, defecatory difficulty, sexual dysfunction or low-back pressure. Severity is graded clinically using the POP-Q (Pelvic Organ Prolapse Quantification) system.

Types of prolapse

• Cystocele — anterior vaginal wall prolapse involving the bladder. Most common type.
• Rectocele — posterior wall prolapse involving the rectum. Often associated with constipation.
• Enterocele — herniation of small intestine into the upper posterior vagina, frequently seen after hysterectomy.
• Uterine prolapse — descent of the uterus into the vaginal canal.
• Vaginal vault prolapse — post-hysterectomy apical descent. Reported in 6–12% after hysterectomy.

POP-Q staging

• Stage 0 — no demonstrable prolapse.
• Stage I — most distal point more than 1 cm above the hymen.
• Stage II — most distal point within 1 cm above or below the hymen.
• Stage III — most distal point more than 1 cm below the hymen.
• Stage IV — complete vaginal eversion (procidentia).

Risk factors

• Vaginal childbirth (prolonged second stage, instrumental delivery, large infant, multiple vaginal births)
• Advancing age — incidence rises after the fifth decade
• Menopause and oestrogen withdrawal
• Chronic raised intra-abdominal pressure — cough, constipation, heavy lifting, obesity
• Prior pelvic surgery, especially hysterectomy
• Connective tissue disorders (Ehlers-Danlos, Marfan)
• Smoking

Pelvic floor muscle training is recommended as a first-line treatment for women with stage I or II symptomatic prolapse. A vaginal pessary remains an effective, low-risk option across all stages.

Diagnosis

POP diagnosis is largely clinical, beginning with structured history and bimanual pelvic examination at maximum Valsalva. POP-Q measurement is recorded for each compartment. Additional evaluation may include urodynamic testing, defecography, pelvic floor ultrasound or MRI for complex cases, and cystoscopy when indicated. At Balaji Horizon, dynamic pelvic floor ultrasound is available in-house.

Treatment options

Conservative measures

• Pelvic floor muscle training with supervised physiotherapy — symptom improvement in 30–70% of patients.
• Lifestyle modification — weight reduction, treatment of chronic cough and constipation.
• Vaginal pessary — silicone device for mechanical support; effective across all stages.
• Topical vaginal oestrogen in postmenopausal women.

Surgical reconstruction

• Vaginal native-tissue repair — colporrhaphy, sacrospinous fixation, uterosacral suspension.
• Laparoscopic/robotic sacrocolpopexy — gold standard for apical/vault prolapse, 90–95% anatomical success at 5 years.
• Uterine-preserving surgery — sacrohysteropexy, Manchester repair.
• Colpocleisis — low-morbidity option for medically frail elderly women.

Following FDA reclassification of transvaginal mesh kits as high-risk Class III devices and NICE 2019 guidance, Balaji Horizon does not use transvaginal mesh. We perform native-tissue vaginal repair and laparoscopic abdominal sacrocolpopexy with type 1 polypropylene mesh.

When to see a specialist

• Visible or palpable vaginal bulge
• Persistent pelvic heaviness, worse at end of day
• Difficulty emptying bladder or bowels
• New urinary incontinence or recurrent UTIs
• Sexual dysfunction related to prolapse
• Failed conservative management

Frequently asked questions

Consult Dr. Priyadatt Patel

Senior Gynecologist · Advanced Laparoscopic Surgeon · Pelvic Floor Reconstruction

Book a Consultation