Pelvic organ prolapse

#### What you need to know A woman’s lifetime risk of surgery for pelvic organ prolapse (POP) is 12-19% with over 300 000 prolapse surgeries performed annually in the US alone.1 2 3 POP accounts for about 15-18% of hysterectomies, and uterovaginal prolapse is the most common indication for hysterectomy in postmenopausal women.4 About one in 12 women living in the community in the UK report symptoms of pelvic organ prolapse.5 POP is the downward decent of the female pelvic organs (vagina, uterus, bladder, and/or rectum) into or through the vagina. This review provides an evidence based update on the epidemiology, evaluation, and management of this condition. Loss of vaginal or uterine support is seen in up to 30-76% of women presenting for routine gynaecology care, with 3-6% of those with descent beyond the vaginal opening (that is, level of the hymen).6 7 8 One population based study found that about 3% of 1961 adult women surveyed reported symptomatic vaginal bulging.9 Prolapse of the anterior vaginal wall, or cystocele, is the most common form of POP, detected twice as often as posterior vaginal prolapse (that is, the rectocele), and three times more common than apical prolapse (uterine and/or post-hysterectomy vaginal vault prolapse) (fig 1⇓).10 11 However in most cases of symptomatic POP, prolapse of multiple segments of the vagina are …