The importance of the pathophysiology of the pelvic organ prolapse in understanding the symptoms of the pelvic floor disorders

O. Ionescu, N. Bacalbașa, N. Saba, G. Bănceanu

Abstract: The prolapse of the pelvic organs (POP), defined as the inferior displacement of one or more of the pelvic organs, is a common pathology whose prevalence is difficult to estimate due to the inhomogeneity of the reported data between the studies. The aim of this review is to present the current literature on the mechanism of the pelvic floor disorders with focus on the importance of the quality of the pelvic conjunctive tissue. In Medline and Pubmed we have introduced the keywords “pelvic organ prolapse” combined with “pelvic organ prolapse and pathophysiology” and “pelvic organ prolapse and risk factors” selecting the articles published until October 2017 in the german and english languages. We have included the systematic reviews, case control studies and metanalyses which have examined the causes of the pelvic floor disorders in the view of the integral theory. The grade of the POP has been defined using the Pelvic Organ Prolapse Quantitation system recommended by the International Society of Continence and the American Society of the Urogynecology. After introducing the above mentioned selection criteria we have chosen 42 articles on primary and secondary POP. In both cases, the main cause of the POP was the deterioration of the pelvic conjunctive tissue as a result of genetic anomalies, pregnancy and parturition or advanced age. Understanding the structure and functions of the pelvic conjunctive tissue will allow a global approach of the pelvic floor by defining the pelvic suspensory ligaments, the consequences that results after weakening the pelvic support structures and the risk factors for a poor quality of the conjunctive tissue.
DOI:10.18643/gieu.2017.151

Keywords: pelvic organ prolapse, conjunctive tissue, ligaments, fascia.