Yes, a Patient Can Have Simultaneous Anterior, Posterior, and Uterine Prolapse
Yes, patients commonly present with pelvic organ prolapse involving multiple compartments simultaneously, including anterior (cystocele/urethrocele), apical (uterine/cervical), and posterior (rectocele) prolapse. 1
Understanding Multi-Compartment Prolapse
Pelvic organ prolapse (POP) typically involves protrusion of anterior or posterior vaginal walls and/or descent of the vaginal apex, and these compartments are frequently affected together rather than in isolation 1. The American College of Radiology explicitly recognizes that:
- POP may involve various compartments of the pelvic floor simultaneously, including the anterior compartment (cystocele and/or urethrocele), apical compartment (uterine/cervical and/or vaginal prolapse), and posterior compartment (rectocele) 1
- Patients usually present with pelvic pressure or bulge and often have other associated pelvic floor dysfunction affecting multiple compartments 1
Clinical Presentation
- The condition represents a combination of compartment involvement in many cases, not isolated single-compartment disease 2
- Prolapse can affect one or more of the anterior, posterior, or apical vagina, with up to 50% of women having some degree of prolapse on examination in their lifetimes 3
- Severe forms can involve concurrent vaginal/uterine and rectal prolapse, even in younger patients, though this is more common in postmenopausal women 4
Diagnostic Approach
- Initial evaluation is clinical and begins with physical examination to determine which vaginal compartments and to what degree prolapse exists 1, 3
- Imaging is reserved for cases where clinical evaluation is difficult or inadequate, or when patients present with persistent or recurrent prolapse symptoms after treatment 1
- Goals of imaging include evaluating for occult pelvic floor disorders in compartments other than those apparent on physical examination 1
Important Clinical Considerations
- Assessment of prolapse (anterior, posterior, apical) as determined by preoperative pelvic examination should be recorded for all patients being considered for surgical treatment 1
- The presence of multi-compartment prolapse influences surgical planning, as surgical procedures for stress urinary incontinence and prolapse may be safely performed concomitantly in appropriately selected women 1
- Few symptoms are specific for prolapse, making it challenging to determine which symptoms are attributable to the prolapse itself and will improve with treatment 5