**1. Introduction**

Vaginal prolapse can be studied in defects at three levels of Prof John Delancey (**Figure 1**).

Usually vault prolapse is associated with anterior and/or posterior wall prolapse. The anterior compartment, the central compartment and the posterior compartment defect. Anterior compartment consists of the bladder and urethra. The central compartment consists of the vaginal vault/uterus. The rectum and perineal body form the posterior compartment. The lateral

> © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**2.** Presence of triggering factors or events (e.g. Coughing, sneezing, lifting, bending, feeling

Recurrent Pelvic Organ Prolapse

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http://dx.doi.org/10.5772/intechopen.76669

**3.** Constant or intermittent urine loss and provocation by minimal increase in intraabdominal pressure. Such as movement, changes in position, and incontinence with an empty bladder

**4.** Associated frequency, urgency, dysuria, pain with a full bladder, and a history of urinary

**6.** Indication of previous Hysterectomy and coexisting complicating or exacerbating medical

**7.** Obstetrical history, including difficult deliveries, episiotomy, grand multiparty, forceps

**8.** Type of previous pelvic surgeries, especially the incontinence procedures, hysterectomy,

**10.** Lifestyle issues like smoking, alcohol or caffeine abuse, and occupational and recreational

**11.** Patients with coexisting pelvic organ prolapse may report dyspareunia, vaginal pain on

**Figure 2.** Vaginal vault prolapse with cystocele and enterocele (Submeatal sulcus and suburethral sulcus is maintained). The leading point of the prolapse is the prolapsed vaginal apex hence also called as apical vaginal prolapse. Diagrammatic representation of the vaginal vault prolapse: the edges of the vaginal apex are held by Allis tissue holding forceps.

factors causing severe or repetitive increase in intraabdominal pressure

**5.** Concomitant symptoms of fecal incontinence or rectal prolapse

use, obstetrical lacerations, and large babies

or pelvic floor reconstructive procedures

**9.** History of spinal and central nervous system surgeries

ambulation, and a bulging sensation in vagina

of urgency)

tract infections

problems like diabetes

**Figure 1.** Professor John De Lancey's support of vaginal vault after hysterectomy as viewed from above and laterally.

compartment defect is the detachment from the arcus tendineus fascia pelvis. The enterocele and posterior compartment dysfunction is the commonest form of post hysterectomy vaginal vault prolapse (**Figure 2**).

Vault prolapse can occur following hysterectomy done for non-prolapse indications if the surgeon at the time of vaginal vault closure does not perform the vault suspension procedure. At the time of abdominal hysterectomy done for benign gynecological diseases like fibroid, adenomyosis, dysfunctional uterine bleeding, the uterosacral ligaments are clamped cut and ligated. The vaginal vault is sutured. This sutured vaginal vault needs to be suspended to the stumps of uterosacral ligaments to support the vagina following hysterectomy. This vital step is the most important point to be remembered by general gynecology practitioners to prevent the occurrence of vault prolapse following hysterectomy.

Recurrent pelvic organ prolapse can be defined as

"The recurrent complaint of something coming down pervaginum, following hysterectomy done for pelvic organ prolapse or other benign gynecological indications". Unfortunately this definition does not take into account the wide variation in this symptom and the underlying etiology. Some women may be asymptomatic while others may have severe symptoms.

Severity and quantity of symptoms that should be considered in history are:

**1.** Duration of complaint and whether the problem has been worsening


compartment defect is the detachment from the arcus tendineus fascia pelvis. The enterocele and posterior compartment dysfunction is the commonest form of post hysterectomy vaginal

**Figure 1.** Professor John De Lancey's support of vaginal vault after hysterectomy as viewed from above and laterally.

Vault prolapse can occur following hysterectomy done for non-prolapse indications if the surgeon at the time of vaginal vault closure does not perform the vault suspension procedure. At the time of abdominal hysterectomy done for benign gynecological diseases like fibroid, adenomyosis, dysfunctional uterine bleeding, the uterosacral ligaments are clamped cut and ligated. The vaginal vault is sutured. This sutured vaginal vault needs to be suspended to the stumps of uterosacral ligaments to support the vagina following hysterectomy. This vital step is the most important point to be remembered by general gynecology practitioners to prevent

"The recurrent complaint of something coming down pervaginum, following hysterectomy done for pelvic organ prolapse or other benign gynecological indications". Unfortunately this definition does not take into account the wide variation in this symptom and the underlying etiology. Some women may be asymptomatic while others may have severe symptoms.

Severity and quantity of symptoms that should be considered in history are:

**1.** Duration of complaint and whether the problem has been worsening

vault prolapse (**Figure 2**).

58 Pelvic Floor Disorders

the occurrence of vault prolapse following hysterectomy.

Recurrent pelvic organ prolapse can be defined as


**Figure 2.** Vaginal vault prolapse with cystocele and enterocele (Submeatal sulcus and suburethral sulcus is maintained). The leading point of the prolapse is the prolapsed vaginal apex hence also called as apical vaginal prolapse. Diagrammatic representation of the vaginal vault prolapse: the edges of the vaginal apex are held by Allis tissue holding forceps.
