Overview of pelvic floor failure and associated problems

Abstract

Pelvic organ prolapse POP, including anterior and posterior vaginal prolapse, uterine prolapse, and enterocele, is a common group of clinical conditions affecting millions of women worldwide. The aim of this review is to highlight the clinical importance of prolapse, its pathophysiology, and different modalities for diagnosis and treatment. POP includes a range of disorders, from asymptomatic disturbed vaginal anatomy to complete vaginal eversion associated with considerable degrees of urinary, defecatory, and sexual dysfunction. The pathophysiology of prolapse is multifactorial however genetically susceptible women are more exposed to life events that result in the development of clinically significant prolapse. The evaluation of women with prolapse requires a comprehensive approach, with focusing on the function in all pelvic compartments based on a detailed patient history, physical examination, and investigations. Although prolapse is associated with many symptoms, few are specific for prolapse; it is often a challenge for the clinician to determine which symptoms are prolapse-specific and will therefore improve or resolve after prolapse treatment. Prolapse treatment is based on specific symptoms moreover its management options fall into two broad categories: nonsurgical, which includes pelvic floor muscle training and pessary use; and surgical, which can be reconstructive or obliterative. Associated symptoms require additional management. All women with prolapse can be treated and their symptoms improved, even if not completely resolved.