Clinical Review Regular review

Management of genital prolapse

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7348.1258 (Published 25 May 2002) Cite this as: BMJ 2002;324:1258
  1. Ranee Thakar, subspecialty trainee in urogynaecology (7YEbthakar@doctors.org.uk),
  2. Stuart Stanton, professor of pelvic reconstruction and urogynaecology
  1. Department of Urogynaecology, St George's Hospital, London
  1. Correspondence to: R Thakar, Department of Obstetrics and Gynaecology, Mayday University Hospital, Croydon CR7

    Prolapse (from the Latin prolapsus, a slipping forth) refers to the falling or slipping out of place of a part or viscus. Pelvic organ prolapse is descent of the pelvic organs into the vagina, often accompanied by urinary, bowel, sexual, or local pelvic symptoms. The incidence of genital prolapse is difficult to determine, as many women do not seek medical advice. It has been estimated that a half of parous women lose pelvic floor support, resulting in some degree of prolapse, and that of these women 10-20% seek medical care.1 In the United Kingdom genital prolapse accounts for 20% of women on the waiting list for major gynaecological surgery.2 The incidence of prolapse requiring surgical correction in women who have had a hysterectomy is 3.6 per 1000 person years of risk; the cumulative risk is 1% at 3 years and 5% at 17 years after a hysterectomy.3 The chance of a woman having a prolapse increases with age.4 Therefore, the incidence of prolapse will rise as life expectancy increases. This article deals with the management in primary care of women with genital prolapse and the options in secondary care.

    Summary points

    Doctors should consider the patient's history of rectal prolapse, bladder and bowel function, and sexual activity

    It is important to treat predisposing factors such as obesity, obstructive airway disease, constipation, and pelvic masses

    Although prolapse can occur in the anterior, middle, or posterior compartments, the pelvic floor should be considered as a single unit in the treatment of prolapse

    When surgery is needed, doctors should check for potential stress incontinence

    There is a lack of good data on the prevention and treatment of prolapse, and in particular more research is needed on the role of pelvic floor exercises and on the pros and cons of vaginal, …

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