The general practitioner's approach to pelvic organ prolapse

Abstract

Pelvic organ prolapse (POP) together with urinary incontinence is extremely common. About 11% of women will receive surgery for these conditions and a third of them will receive a second operation within two years. The general practitioner should be on the lookout for POP as patients may not reveal it. Parous patients with bladder symptoms, a fullness or pressure in the pelvis, or rectal symptoms (mainly obstructive defaecation) are candidates for POP, particularly in those with a previous hysterectomy. Patients in need for surgery (referral) are those with stage 3 and 4 prolapse (in or outside the introitus), or stage 2 prolapse with severe symptoms. Surgery for POP has undergone a transformation in recent years with the introduction of new surgical methods and the use of mesh to reinforce weakened pelvic support systems. However, conservative measures such as physiotherapy and medication still play a role for lesser degree of prolapse or urinary symptoms. A vaginal pessary can be used for uterine prolapse in extremely elderly women.