Genital Prolapse

Genital Prolapse:

Genitourinary prolapse occurs when there is descent of one or more of the pelvic organs including the uterus, bladder, rectum, small or large bowel, or vaginal vault.

The anterior and/or posterior vaginal walls, the uterus and the vaginal vault can all be affected by this descent.
There is resulting protrusion of the vaginal walls and/or the uterus. It is usually accompanied by urinary, bowel, sexual, or local pelvic symptoms
Patho-physiology:
The pelvic organs are mainly supported by the levator ani muscles and the endopelvic fascia (a connective tissue network connecting the organs to the pelvic muscles and bones).
Genitourinary prolapse occurs when this support structure is weakened through direct muscle trauma, neuropathic injury, disruption or stretching.

A multifactorial cause for this damage is likely.

The orientation and shape of the bones of the pelvis have also been implicated in the pathogenesis of genitourinary prolapse.
Confirmed risk factors:
Increasing age (risk doubles with each decade of life).
Vaginal delivery.
Increasing parity.
Overweight (BMI 25-30) and obesity (BMI >30).
Spina bifida and spina bifida occulta.
Possible risk factors:
Intrapartum variables (controversial and unproven):
Fetal macrosomia