Pelvic organ prolapse arises from ...

Pelvic organ prolapse arises from a weakening of connective tissue or los of muscular support. Risk factors include vaginal delivery, with a 10 percent increased risk of harsh prolapse for each additional enclose of infant birthweight. Although numerous risk factors are involved, high-impact occupational or recreational activities and increasing age are principally often implicated. Cundiff discussed an 80-year-old woman with vaginal prolapse.

Patients with vaginal prolapse can existing with a variety of symptoms including sexual, urinary, and bowel complaints. The physical examination focuses in succession the pelvic area but includes an evaluation of mental and nutritional status, mobility, abdominal wall integrity, and a neurologic examination. Ancillary standards often are used for patients who have urinary incontinence in addition to pelvic organ prolapse.

Patients with pelvic organ prolapse have three treatment options: nonsurgical approaches, surgical approaches, and observation. For mildly symptomatic pelvic organ prolapse, observation is a reasonable approach because of a one-year regression rate of 48 percent for uterine pelvic organ prolapse and a reoperation rate of up to 30 percent Although studies of Kegel exercises address single their effectiveness in managing urinary incontinence, the exercises were propos originally as a way to strengthen pelvic support.

Pessaries are available in space-occupying and supportive varieties. The poor retention of pessaries has been associated with a vaginal long duration of 6 cm or les and a wide vaginal introitus. These complications can be reduc with convenient fitting and good pessary care.

Surgical options include reconstructive practices through a vaginal, abdominal, or laparoscopic approach, or a combination of these. Obliterative courses are an option only for women who do not plan to engage in further coital activity. Otherwise, data do not support common option over another.

The author ends that future research is extremityed to assess the functional results of the surgical management of pelvic organ prolapse. Observation and pessaries should be evaluated to determine which patients are more likely to benefit from their use, and physicians ne to identify patients in whom restorative approaches are likely to fail.

CAROLINE WELLBERY, MD

Cundiff GW An 80-year-old woman with vaginal prolapse. JAMA April 27 2005;293:2018-25

COPYRIGHT 2005 American Academy of Family Physicians

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