Prolapse is the falling down or slipping of a body part from its usual position. It is essentially a hernia, a weakness of support tissue which allows protrusion of one structure through another. When a hernia occurs in the pelvis, it is referred to as pelvic organ prolapse of which there are several types: cystocele (the bladder), rectocele (the rectum or large bowel), enterocele (the small bowel), uterine prolapse (the womb) or vaginal vault prolapse, which can occur after hysterectomy. Prolapse can be asymptomatic, or result in symptoms of vaginal fullness, protrusion of tissue through the vagina, difficulty in urinating or defecating, or irritation of protruding tissue. Treatment includes the use of pessaries or various surgical options including laparoscopic or vaginal reconstructive operative procedures.
Prolapse is divided into classifications based on where exactly the prolapse is, and how severe it is. Prolapses in which other organs herniated toward the front wall of the vagina are called “Anterior Compartment Prolapses”. Prolapses in which the top of the vagina, with or without the uterus, falls, are known as “Apical Compartment Prolapses”. Prolapses in which the bowel or rectum protrudes toward the back wall of the vagina are called “Posterior Compartment Prolapses”. Not uncommonly, several types of prolapse are present at the same time. Prolapses are further divided by severity. There are many elaborate ways to classify the severity of a prolapse, but the simplest is a Grade 1-3 system, in which Grade 1 is the herniation of an organ into the vagina that stays above the hymen with straining. Grade 2 is a protrusion to the hymen and Grade 3 is a protrusion past the hymen, right through the introitus. Grade 3 prolapses often need to be pushed up (or “reduced”) by the patient after straining. They can be alarming to people the first time they are noticed.