PELVIC ORGAN PROLAPSE

A   62-year-old woman   complains   of  low back    pain    and perineal    pressure    for

18  months. She had been    recommended by  another physician   to  wear    a

pessary,    which   she is  reluctant   to  do. On  pelvic  examination a   second-

degree  uterine prolapse    with    a   cystocele   and a   rectocele   is  observed.

The pelvic floor is made up of the diaphragm and perineal membrane.

The etiology of pelvic relaxation is most commonly related to childbirth. The
mechanical trauma of childbirth stresses and tears the supporting ligaments of
the pelvic retroperitoneum in the pelvis, whose main function is to support the
pelvic viscera. Advancing age and obesity are risk factors for pelvic organ
prolapse (POP).

The components of pelvic relaxation include uterine prolapse, cystocele,
rectocele, and enterocele. Lesser forms of pelvic relaxation include vaginal or
vault prolapse.

The pelvic  diaphragm   consists    of  the levator ani and coccygeus   muscles.    The

levator ani consists    of  three   muscles:    puborectalis,   pubococcygeus,  and

iliococcygeus.

The perineal    membrane    is  a   triangular  sheet   of  dense   fibromuscular   tissue

that    spans   the anterior    half    of  the pelvic  outlet. The vagina  and the urethra

pass    through the perineal    membrane    (urogenital diaphragm).

The main    structures  that    support the uterus  are the cardinal    ligaments,  the

uterosacral ligaments,  and the endopelvic  fascia.