Pelvic Organ Prolapse

Question 1

How is the female pelvic floor supported anatomically?

Answer 1

3 distinct layers:

1 - Endo-pelvic fascia

2 - Pelvic diaphragm

3 - Urogenital diaphragm

Question 2

What are the predisposing factors for uterovaginal prolapse?

Answer 2

1) Forceps delivery
2) Large baby
3) Prolonged 2nd stage of labour
4) Increasing parity
5) Advancing age
6) Obesity
7) Previous pelvic surgery
8) Constipation
9) Hig-impact aerobic & long distance running

Question 3

What are the different types of prolapse?

Answer 3

1) Urethrocele (lower anterior vaginal wall involving urethra only)
2) Cystocele (upper anterior vaginal wall involving bladder)
3) Uterovaginal (prolapse of uterus, cervix & upper vagina)
4) Enterocele (prolapse of upper posterior wall of vagina containing loops of small bowel)
5) Rectocele (lower posterior wall of vaginainvolving rectum bulging forwards into vagina)

Question 4

What are the available systems for examining and grading POP?

Answer 4

1) POPQ score (gold standard)
2) Examination of the pelvis to exclude pelvic mass
3) Assess the impact the POP has on the patients quality of life

Question 5

What are the principles of conservative and surgical management of POP?

Answer 5

Conservative:

1) Pelvic floor muscle training
2) Pessaries - a device inserted into vagina to support the uterus

Surgical:

• Relieves symptoms
• Restores bladder and bowel function
• Maintain vaginal capacity for sexual function