ABSTRACT
Pelvic organ prolapse and pelvic floor relaxation are common problems in older multiparous
women, affecting 16% of women aged 40-56 (1). A detailed knowledge of pelvic anatomy is paramount for the proper evaluation and management of such patients. Pelvic support defects
result from both neurophysiologic and anatomic changes (2) and often occur as a constellation
of abnormal findings. Although a thorough pelvic examination is always indicated, even
experienced clinicians may be misled by the physical findings, having difficulty differentiating
among cystocele, enterocele, and high rectocele by physical examination alone. Depending on
the position of the patient, strength of Valsalva maneuver, and modesty of the patient, the
surgeon may be limited in his or her ability to accurately diagnose the components of pelvic
prolapse. Furthermore, with uterine prolapse, the cervix and uterus may fill the entire introitus,
making the diagnosis of concomitant pelvic prolapse even more difficult. Regardless of the
etiology of the support defect, the surgeon must identify all aspects of vaginal prolapse and
pelvic floor relaxation for proper surgical planning. Accurate preoperative staging should
reduce the risk of recurrent prolapse. Radiographic evaluation plays an important role in the
identification of these defects, and should be used as an extension of the physical examination.
II. ANATOMY
