pelvic floor/pop

• Superior boundary of the pelvic cavity is the pelvic inlet
• Inferior boundary of the pelvic cavity is a group of muscles/fascia called the pelvic floor
• Pelvic floor


  • Separates pelvic cavity from perineum
  • Contains levator ani (puborectalis, pubococcygeus, iliococcygeus)
  • Contains coccygeus
• Pathophysiology of pelvic organ prolapse

  Increased abdominal pressure due to damage to the levator ani, endopelvic fascia, cardinal/uterosacral complex, perineal body
• Risk factors for pelvic organ prolapse

  • Multiparity
  • Genetic predisposition
  • Advanced age
  • Menopause
  • Prior pelvic surgery
  • Connective tissue disorders
  • Increased abdominal pressure (obesity, strain from chronic constipation/cough)
  • Collagen disorders (EDS)
  • Chronic cough
• Herniation/protrusion of pelvic organs into/out of vaginal canal is a key finding for pelvic organ prolapse diagnosis
• Clinical findings for pelvic organ prolapse

  • Sensation of bulge/protrusion in vagina
  • Urinary/fecal incontinence
  • Constipation
  • Sensation of incomplete bladder/bowel emptying
  • Dyspareunia
• Bimanual exam with Valsalva can help show where prolapse is
• Treatment options for pelvic organ prolapse

  • High fiber diet
  • Laxatives
  • Stool softeners for constipation
  • Weight loss
  • Limit strain/heavy lifting
  • Kegel exercises
  • Pelvic floor physical therapy
• Pessaries can reduce cystocele, rectocele, or enterocele in patients who do not desire surgery or cannot
• Complications of using pessaries

  • Vaginitis
  • Vaginal infections
  • Erosions/ulcerations
  • Severe bowel/bladder problems
  • Urinary stress incontinence (due to changed urethrovesical angle)
• Key findings associated with pelvic organ prolapse

  • Cystocele
  • Enterocele
  • Rectal prolapse/Rectocele
  • Uterine prolapse
• Cystocele


  An anterior compartment prolapse; anterior vaginal wall associated with descent of bladder
• Enterocele


  A vaginal vault hernia with small bowel, normally in posterior vagina
• Rectal prolapse/Rectocele


  A posterior compartment prolapse; hernia of posterior vaginal segment associated with rectum
• Uterine prolapse


  Prolapse of uterus into vaginal vault
• Urinary stress incontinence occurs because the urethrovesical angle is changed when using a pessary for a cystocele