Pelvic organ prolapse, as referred to in this text, is a term encompassing a number of anatomically proximate yet distinct entities. This chapter consists of a brief review of anatomy followed by a discussion of the identification and management of rectocele, vaginal prolapse, cystocele, enterocele, urethral prolapse, and ureteral prolapse. These conditions are primarily found in parous females as well as women at both extremes of age. Additionally, these conditions may occur separately or together, depending on the type and degree of pelvic floor relaxation.

A rectocele is a prolapse of the rectum through the posterior vaginal vault, whereas rectal prolapse occurs when some or all of the layers of the rectum extend out beyond the anal sphincter. Uterine prolapse refers to various degrees of uterine descent through the vaginal vault and even past the vaginal introitus in severe cases. Vaginal vault prolapse may be found in a patient with a previous hysterectomy. Cystoceles are caused by prolapse of the bladder through the anterior wall of the vaginal vault and may contain the urethra as part of the prolapsing organ complex (cystourethrocele). An enterocele is a true herniation of the peritoneum and small bowel through the upper posterior portion of the vagina. Urethral prolapse is defined as urethral mucosa that has everted and protrudes through the urethral meatus. Much less commonly, ureterocele prolapse may occur when a ureterocele extends from the bladder through the urethra and is visible at the urethral meatus.

The underlying mechanism that predisposes a patient to most of these conditions is loss of normal pelvic support via several possible causes. As a rule, the most common etiology stems from trauma from childbirth or hysterectomy. Other possible causes are from traumatic or surgical injury, heavy physical labor, chronic coughing, congenital defects, and postmenopausal tissue atrophy from hormonal changes.<sup>34 Wahle G.R., Young G.P., Raz S. Anatomy and pathophysiology of pelvic support Female Urology Philadelphia: WB Saunders (1996). 

Cliccare qui per andare alla sezione Riferimenti</sup> Stress urinary incontinence is typically an early feature experienced by many of these patients, but other causes for incontinence should be considered as well (see chapter entitled “Urinary Incontinence” for complete differential). In general, these conditions are infrequently seen by most emergency physicians, yet a basic understanding of their pathophysiology is necessary for proper recognition, acute intervention, and timely referral for definitive care. Additionally, these patients may present postoperatively to the emergency department after surgical repair of their prolapse condition, and knowledge of the disease processes allows for diagnosis and treatment of potentially serious complications.