Pelvic Organ Prolapse

Question 1

What is a prolapse?

Answer 1

Protrusion of an organ/structure beyond its normal confines.

Question 2

Where do female pelvic organs prolapse?

Answer 2

towards or through the vagina
within the vagina
Beyond the vagina

Question 3

What is a prolapse beyond the vagina called?

Answer 3

Externalisation

Question 4

What are risk factors of a pelvic organ prolapse?

Answer 4

PARITY - strongest risk
Large baby 
Vaginal deliveries
Instrumental births 
chronic constipation
chronic coughing (asthma, COPD) 
obesity 
increasing age/menopause
Prolonged 2nd stage of labour
previous pelvic surgery
Fit and thin

Question 5

What is the cause of pelvic organ prolapse?

Answer 5

A weakness in the pelvic muscles and ligaments

Question 6

What are the signs and symptoms of a pelvic organ prolapse?

Answer 6

Worse when bearing down
sex - pain or reduced pleasure
urinary - stream, urgency, incontinence, retention
bowel - urgency, constipation

Question 7

What are the 3 layers of the pelvic floor?

Answer 7

Endo-pelvic fascia = fibro-muscular (muscular part can be trained)
Pelvic diaphragm = striated muscles
Urogenital diaphragm = the perineal muscles and fascia

Question 8

What is the main muscle of the pelvic floor?

Answer 8

Levator Ani

Question 9

Which ligament holds the uterus and cervix up?

Answer 9

Utero-sacral ligament

Question 10

Which fascia holds the bladder and vagina in place?

Answer 10

Pubocervical fascia

Question 11

What fascia holds the rectum and vagina in place?

Answer 11

Rectovaginal fascia

Question 11

What fascia holds the rectum and vagina in place?

Answer 11

Rectovaginal fascia

Question 12

What can cause an anterior vaginal prolapse?

Answer 12

Cystocoele - bladder
urethrocoele - urethra
cystourethrocoele - Bladder and urethra

Question 13

What can cause a posterior vaginal prolapse?

Answer 13

Rectocoele - rectum

Enterocoele - small intestines

Question 14

What causes an apical vaignal prolapse?

Answer 14

Prolapse of uterus, cervix and vagina

Hysterectomy

Question 15

What is an apical prolapse?

Answer 15

Prolapse of uterus, cervix and vagina

Hysterectomy

Question 16

What are vaginal prolapse symptoms?

Answer 16

Sense of bulge
can't insert tampons
pressure
heaviness
painful sex

Question 17

What are urinary prolapse symptoms?

Answer 17

Incontinence
frequency
urgency
poor stream
retention

Manual reduction of prolapse improves stream

Question 18

What are rectal prolapse symptoms?

Answer 18

incontinence
change in stool consistency
difficulty cleaning
incomplete emptying 
urgency

Question 19

What 2 types of assessment are used in pelvic organ prolapse?

Answer 19

POPQ = gold standard

Baden walker
POPQ - pelvic organ prolapse quantification

• shows how severe he prolapse is

Question 20

What are the investigations for pelvic organ prolapse?

Answer 20

NONE - clinical diagnosis.

Investigations are for associated symptoms only.

Question 21

What is the treatment of POP stage 1 and 2 (Milder)?

Answer 21

Physiotherapy - pelvic floor muscle training

NOT used in severe cases (stage 3 and 4 where prolapse is outside the vagina)

Pessaries

Question 21

What is the treatment of POP stage 1 and 2 (Milder)?

Answer 21

Physiotherapy - pelvic floor muscle training

NOT used in severe cases (stage 3 and 4 where prolapse is outside the vagina)

Pessaries

Question 22

Which pessary is most compatible with sex?

Answer 22

Ring pessary - most commonly inserted by the GP.

Silicone based pessaries are used today.

There is equal satisfaction of pessaries vs surgery.

Question 23

What type of surgeries can be done for pelvic organ prolapse?

Answer 23

Anterior vaginal wall repair
Posterior vaginal wall repair
Hysterectomy
Hysteropexy (surgical fixation of displaced uterus)
Colpocleisis (vaginal closure, only if no more sex)
Sacrospinous fixation

Question 24

How many people does POP affect?

Answer 24

50% of multiparous women, 10% have symptoms.