Urogynaecology (2)

Question 1

Pelvic Organ Prolapse:
What is this due to?

What occurs in a Uterine prolapse?
→ How is a vault prolapse different?

What occurs in a Cystocele?

What occurs in a Rectocele?
→ What is this associated with?

Answer 1

➊ Due to weakness and lengthening of ligaments and muscles around uterus, rectum and bladder

➋ Defect in apical vaginal wall, allowing uterus to decend into vagina
→ Roof of vagina descends further down (more common in those w/hysterectomy)

➌ Defect in anterior vaginal wall, allowing bladder to prolapse backwards

➍ Defect in posterior vaginal wall, allowing rectum to prolapse forwards
→ Constipation and faecal loading – This can, in turn, worsen constipation and cause urinary retention due to urethral compression

Question 2

How does it present?

Answer 2

• Feeling of something coming down into vagina
• Dragging or heavy sensation in pelvis
• Associated urinary or bowel symptoms
• Sexual dysfunction

Question 3

Management:
Who’s the conservative option for?
→ What does it involve?

What are the other options?

Answer 3

➊ Those coping with mild symptoms, don’t tolerate pessaries, or aren’t suitable for surgery
→ Pelvic floor exercise, weight loss, lifestyle changes, and symptomatic relief

➋ • Vaginal pessary
‣ Provides extra support to pelvic organs – Can cause significant improvement in symptoms and can be removed and replaced easily
• Surgery