1.What is pelvic organ prolapse The female pelvis contains the uterus, vagina, intestines and bladder. The fascia, muscles and ligaments of the pelvic floor together form a strong “support” to maintain the normal position of the female pelvic organs. Pelvic organ prolapse is a condition in which the pelvic floor tissues are weak, causing the pelvic organs to drop and their position and function to become abnormal. The disease is common in middle-aged and elderly women and, together with stress urinary incontinence abnormalities, is a pelvic floor dysfunctional disease. According to the site of prolapse, pelvic organ prolapse can be classified as uterine prolapse, vaginal vault prolapse, anterior vaginal wall bulge, posterior vaginal wall bulge and uterine rectal fossa hernia. Many patients have multiple sites of prolapse at the same time. The degree of pelvic organ prolapse is generally classified as mild, moderate, or severe, or I, II, III, or IV. The management of pelvic organ prolapse can be divided into follow-up observation, non-surgical treatment and surgical treatment. 2.Why does the uterus prolapse Medical research confirms that pregnancy and childbirth are the main causes of uterine prolapse. If the fetus is too large, the fetal position is not correct, and the birth injury will aggravate the damage of pelvic floor muscles and nerves. In the past, women gave birth more frequently, did not have sufficient rest after childbirth due to the needs of life and work, and labored too early, so the incidence of uterine prolapse was high. Prolapse mostly manifests itself after menopause and worsens with age. If the pelvic floor tissues are under excessive pressure for a long time, such as excessive obesity, chronic cough, constipation, and lifting heavy objects, it can also contribute to the development of the disease. In addition, family genetic disorders, such as Marfan’s syndrome, are also associated with the disease. In short, uterine prolapse is the result of the combined effect of genetic and environmental factors. The most obvious symptom of pelvic organ prolapse is that the patient feels that the organ is prolapsed outside the vaginal opening, and the symptoms are obvious after prolonged standing or exertion, and reduced after bed rest, but in severe cases, it cannot be returned, and there is increased discharge, ulceration and bleeding. In the case of anterior vaginal wall bulge, it may be accompanied by urinary symptoms such as difficulty in urination, incomplete urination, urinary frequency, urinary urgency and urinary incontinence. In posterior vaginal wall bulge, patients may have bowel symptoms such as constipation and difficulty in defecation. Some people have uncomfortable sensations during sexual intercourse. It is especially important to point out that pelvic organ prolapse can lead to urination, defecation and sexual dysfunction, but it is not the only cause. For example, long-term urinary retention can also lead to frequent and urgent urination, and age, eating habits and pelvic floor muscle coordination are all related to the disease, which can be said to have multiple causes and one effect. Therefore some patients have no good improvement in urinary tract function and defecation dysfunction despite the prolapse reset after surgery. 4, the uterine prolapse must be operated after the uterine prolapse, the doctor will be based on the patient’s age, fertility requirements, symptoms, severity, willingness and other factors to develop a reasonable treatment plan. The most effective and proven non-surgical treatments are uterine support, pelvic floor rehabilitation and behavioral guidance. Conservative treatment can relieve symptoms, prevent prolapse from worsening, and avoid or delay surgery, and is mainly suitable for patients with symptoms of I-II degree prolapse, or patients with severe prolapse who wish to preserve their reproductive function and cannot be treated surgically. Uterine trays are very effective, and the doctor will choose the right shape and size of uterine trays for the patient to try on according to the condition, and finally select the most suitable model. Some types of uterine supports do not even interfere with sexual life, but it is important to follow up closely and regularly and remove them regularly. Pelvic floor muscle training is a kind of pelvic floor rehabilitation treatment, the method is simple, easy to implement, can strengthen the weak pelvic floor muscle strength, enhance the pelvic floor support, improve the symptoms of mild to moderate prolapse, stop the development of the disease, but must reach a considerable amount of training to be effective. 5.How to choose the surgery method Patients with obvious prolapse symptoms and ineffective conservative treatment can consider surgery. Doctors will consider various factors, such as age, surgical history, severity of prolapse, whether or not there is a sexual life, the location of the prolapse, and the general condition to choose the most suitable surgical method. Generally speaking, there are two options: reconstructive surgery and vaginal closure surgery, with the former being more commonly used. Reconstructive surgery is performed to restore the position of the organ and preserve sexual function, usually with a simultaneous hysterectomy, while in younger patients the uterus can be preserved; usually transvaginal surgery, but also transabdominal and laparoscopic surgery. The surgical methods are autologous tissue reconstruction and reconstruction with mesh. The mesh is further divided into absorbable mesh, which is a biological patch synthesized from animal tissue that will be absorbed by the body and slowly disappear, and non-absorbable mesh, which will remain permanently in the body. There is also a composite mesh, which consists of absorbable and non-absorbable materials. In general, mesh is suitable for patients with recurrence, or those at risk of surgical failure, especially older patients with severe prolapse.