POP is the Phenomenon of "loss of support of the pelvic organs (uterus, vagina, bladder, rectum) with subsequent “Falling” or “Bulging out” of the organs (as a result of upright posture).

  POP is a very common problem especially among older women.  Estimated ½ women who have children will have prolapse in later life, but actual prevalence not known because may be women did not seek help.

  The pelvic organs are being supported by ligaments and pelvic floor muscles to keep them in normal position.  Any damage to these support structure may cause prolapse.

Causes:
Exact reason unknown.  The followings may predispose to prolapse:
-Pregnancy & childbirth, e.g. multiparity, long labour, traumatic delivery
-Aging & weaken muscles, decrease in elasticity of ligaments, atrophic muscles
-Post menopausal : Due to hormone deficiency, speed up atrophy
-Post surgery, e.g. previous hysterectomy with poor support from vaginal vault, continence surgery
-Chronic increase in abdominal pressure, e.g. obesity, heavy lifting, chronic cough and constipation, etc.

Signs and Symptoms
Depends on the site and severity of prolapse, common symptoms include:

General
-Lump in vagina/  introitus
-Feeling of “heaviness”
-Low back pain
-Difficulty in coitus

Cystocele
-Frequency
-Voiding difficulty (need to reduce to aid voiding)
-Incontinence

Rectocele
-Difficulty in passing bowel
-Need to digitate for bowel opening
-Difficulty in coitus

Symptoms usually better after sleeping in the morning and worse at the end of the day (night)

Treatment
Depends on the symptoms and severity.
-Mild asymptomatic prolapse does not need treatment, although they might get worse with age.
-Asymptomatic prolapse can be treatment by non-surgical or surgical means.

Non-surgical
Ring pessary
-Provide temporary relief
-Need to come back for regular follow up and change of pessary
-Can lead to ulceration if too big or left in vagina for too long

Surgical
Many types available, the aims of surgery
-Restore support
-Restore urinary & bowel function
-Preserve vagina for coital function 

We hereby thanks Dr. Mak Ho Leung for the provision of the above information