Epidemiology
Etiology
- Etiology: insufficiency of the pelvic floor muscles and the ligamentous supportive structure of the uterus and vagina

- Risk factors:
- Multiple vaginal deliveries and/or traumatic births (greatest risk factor)
- Low estrogen levels (e.g., during menopause)
- Increased intraabdominal pressure (due to, e.g., obesity, cough related to chronic lung disease and/or smoking, ascites, pelvic tumors, constipation)
Pathophysiology
- Specific sites
- Vaginal wall prolapse
- Anterior vaginal wall prolapse: herniated anterior vaginal wall, which is often associated with a cystocele (descent of the bladder) or urethrocele (descent of the urethra); can be due to weakness of the pubocervical fascia; Most common type.
- Posterior vaginal wall prolapse: herniated posterior vaginal wall, which is associated with a rectocele (descent of the rectum) or enterocele (herniated section of the intestines); can be due to weakness of the rectovaginal fascia
- Uterine prolapse: descent of the uterus
- Vaginal vault prolapse: descent of the apex of the vagina
- Apical compartment prolapse: herniated uterus, cervix, or vaginal vault
- Uterine procidentia: protrusion of all vaginal walls or cervix beyond the vaginal introitus
Clinical features
- Feeling of pressure on or discomfort around the perineum (“sensation of vaginal fullness”)
- Lower back and pelvic pain (may become worse with prolonged standing or walking)
- Rectal fullness, constipation, incomplete rectal emptying
- Prolapse of the anterior (most common) or the posterior vaginal wall
- Weakened pelvic floor muscle and anal sphincter tone
Diagnostics
Treatment