PELVIC ORGAN PROLAPSE (POP)

• Pelvic organ prolapse is the descent of the genital organs beyond their normal anatomical confines
• It is caused by herniation through deficient pelvic fascia or due to weakness or deficiency of the ligaments or muscles or deficient blood or nerve supply to the organs
• Commonly seen in women of advanced age
• Partial/subtotal prolapse: pelvic organs are only partially outside the vaginal opening
• Total prolapse: pelvic organs are everted and located outside of the vaginal opening

• Genital prolapse occurs due to weakness of the structures supporting the organs in position

Predisposing factors

• Acquired – Vaginal delivery with consequent injury to the supporting structures
• Congenital – congenital weakness of supporting structures
• Ageing
• Post-operative – Poor attention to vaginal vault support can lead to vault prolapse
• Prior pelvic surgery
• Connective tissue disorders
• Increased intra-abdominal pressure secondary to obesity or chronic constipation

• Pressure, pain, or fullness in vagina or rectum or both
• Vaginal tissue bulge – a sensation of falling out
• Urinary incontinence
• Urine retention
• Faecal incontinence
• Chronic constipation
• Back or pelvic pain
• Dyspareunia
• Vaginal bleeding and increased vaginal discharge
• Prolapse of the anterior (in cystocele /urethrocele) or the posterior (in enterocele /rectocele) vaginal wall, possibly with excessive vaginal discharge
• Weakened pelvic floor muscle and anal sphincter tone

 Degrees of uterine prolapse

• 1st degree – Descent within the vagina
• 2nd degree – Descent to the introitus
• 3rd degree - (Procidentia /complete collapse) – Descent outside the introitus

• Urine analysis, microscopy, culture, and sensitivity
• Cystography
• Pelvic and abdominal USG
• Routine pre-operative investigations – Blood chemistry, CBC, kidney, and liver function tests

POP – Quantitative scoring

• Stage 0 -No descent of pelvic organs 
• Stage 1 - Leading edge of the prolapse remains 1cm or more above the hymenal ring 
• Stage 2-Leading edge of the prolapse extends from 1cm above to 1cm below the hymenal ring 
• Stage 3-From 1cm beyond the hymenal ring but without complete vaginal eversion
• Stage 4-Essentially complete eversion of vagina

Preventive

• Adequate ANC and Intra natal care
• Adequate postnatal care
• Contraceptives
• Avoid strenuous activities, chronic cough, constipation, and heavy weight lifting

Conservative 

• Improvement of general health
• Estrogen replacement therapy
• Pelvic floor exercise
• Pessary treatment

Surgical

• Restorative
• Extirpative – removing the uterus and correcting the supporting tissue
• Obliterative

Ayurvedic Treatment

Internal Medicines

• Sukumara Kashaya
• Gandha Taila 
• Dhanwantara taila

 Procedures

• Swedana 
• Anuvasana vasti - Sukumara Taila, Bala Taila, Sirisa Taila 
• Uthara Vasti - Sukumara Taila, Bala Taila, Sirisa Taila 
• Vesavara Dharana