**8. Management of pelvic organ prolapse**

Pelvic organ prolapse is the descent of the pelvic organs into the vagina.The about half of multiparous women have some loss of pelvic floor support however 10–20% of them seek medical advice. The prolapse can be anterior (bladder and urethral) prolapse or posterior (rectal) prolapse or mid compartment (uterine or vault) prolapse. The degree of decent is classified through "The Baden-Walker classification" into four grades [25, 26].


Prolapse patient presents usually with variety of symptoms including vaginal lump and discomfort, dragging sensation, backaches as well as lower urinary tract symptoms such as urgency and frequency and feeling of incomplete emptying and needing to adjust position to help bladder emptying. Bowel symptoms associated with prolapse vary from constipation to obstructive defecation and needs for vaginal digitation to help bowel emptying [27, 28].

Prolapse has it is impact on the quality of life from physical point of view as well as implications on sexual life [25].

Urogynaecology nurse specialist should be able to assess the patient symptoms and and the assess the degree of prolapse which can be counter checked by the clinician if needed. Provide the patient with leaflets and identify any predisposing factors that participate in making the prolapse worth such as high BMI, chronic cough in patients with chronic lung disease and chronic constipation as well as implication of the prolapse on managing day to day activity and patients sexual life.

### **8.1 Conservative management**

Conservative treatment may be appropriate, although prolapse is a mechanical problem that in general, when patients are fit, is treated surgically [25, 28].
