pelvic organ prolapse pelvic organ prolapse pelvic organ prolapse (pop) is characterized by descent of pelvic organs from their normal positions. in women, the condition usually occurs when the pelvic floor collapses after gynecological cancer treatment, childbirth or heavy lifting. pelvic organ prolapseother namesfemale genital prolapsespecialtygynecologyfrequency316 million women (9.3% as of 2010) in men, it may occur after the prostate gland is removed. the injury occurs to fascia membranes and other connective structures that can result in cystocele, rectocele or both. treatment can involve dietary and lifestyle changes, physical therapy, or surgery. types anterior vaginal wall prolapse cystocele (bladder into vagina) urethrocele (urethra into vagina) cystourethrocele (both bladder and urethra) posterior vaginal wall prolapse enterocele (small intestine into vagina) rectocele (rectum into vagina) sigmoidocele apical vaginal prolapse uterine prolapse (uterus into vagina) vaginal vault prolapse (roof of vagina) – after hysterectomy grading pelvic organ prolapses are graded either via the baden–walker system, shaw's system, or the pelvic organ prolapse quantification (pop-q) system. shaw's system anterior wall upper 2/3 cystocele lower 1/3 urethrocele posterior wall upper 1/3 enterocele middle 1/3 rectocele lower 1/3 deficient perineum uterine prolapse grade 0 normal position grade 1 descent into vagina not reaching introitus grade 2 descent up to the introitus grade 3 descent outside the introitus grade 4 procidentia baden–walker baden–walker system for the evaluation of pelvic organ prolapse on physical examination gradeposterior urethral descent, lowest part other sites 0normal position for each respective site 1descent halfway to the hymen 2descent to the hymen 3descent halfway past the hymen 4maximum possible descent for each site pop-q main article: pelvic organ prolapse quantification system pop-q points pelvic organ prolapse quantification system (pop-q) stagedescription 0no prolapse anterior and posterior points are all −3 cm, and c or d is between −tvl and −(tvl−2) cm. 1the criteria for stage 0 are not met, and the most distal prolapse is more than 1 cm above the level of the hymen (less than −1 cm). 2the most distal prolapse is between 1 cm above and 1 cm below the hymen (at least one point is −1, 0, or +1). 3the most distal prolapse is more than 1 cm below the hymen but no further than 2 cm less than tvl. 4represents complete procidentia or vault eversion; the most distal prolapse protrudes to at least (tvl−2) cm. management vaginal prolapses are treated according to the severity of symptoms. non-surgical with conservative measures, such as changes in diet and fitness, kegel exercises, and pelvic floor physical therapy. with a pessary, a rubber or silicone rubber device fitted to the patient which is inserted into the vagina and may be retained for up to several months. pessaries are a good choice of treatment for women who wish to maintain fertility, are poor surgical candidates, or who may not be able to attend physical therapy. pessaries require a provider to fit the device, but most can be removed, cleaned, and replaced by the woman herself. pessaries should be offered as a non-surgical alternative for women considering surgery. surgery surgery (for example native tissue repair, biological graft repair, absorbable and non-absorbable mesh repair, colpopexy, or colpocleisis) is used to treat symptoms such as bowel or urinary problems, pain, or a prolapse sensation. when operating a pelvic organ prolapse, introducing a mid-urethral sling during or after surgery seems to reduce stress urinary incontinence. transvaginal repair seems to be more effective than transanal repair in posterior wall prolapse, but adverse effects cannot be excluded. according to the fda, serious complications are "not rare." evidence does not support the use of transvaginal surgical mesh compared with native tissue repair for anterior compartment prolapse owing to increased morbidity. for posterior vaginal repair, the use of mesh or graft material does not seem to provide any benefits. compared to native tissue repair, transvaginal permanent mesh likely reduces both the perception of vaginal prolapse sensation, and the risk of recurrent prolapse and of having repeat surgery for prolapse. however, transvaginal mesh (tvm) has a greater risk of bladder injury and of needing repeat surgery for stress urinary incontinence or mesh exposure. also, the use of a tvm in treating vaginal prolapses is associated with side effects including pain, infection, and organ perforation. safety and efficacy of many newer meshes is unknown. thousands of class action lawsuits have been filed and settled against several manufacturers of tvm devices. epidemiology genital prolapse occurs in about 316 million women worldwide as of 2010 (9.3% of all females). research to study pop, various animal models are employed: non-human primates, sheep, pigs, rats, and others.