Prolapse Flashcards
What is prolapse?
Protrusion of an organ or structure beyond its normal anatomical confines
What is Female POP?
descent of the pelvic organ towards or through the vagina
What is the scale of POP
12-30% multiparous
2% of nulliparous
2% symptomatic and 50% non-symptomatic
Indication of hysterectomies is majorly prolapse
The pelvic floor anatomy
Flexible to withstand changes of volumes and pressure
Bottom of the abdomino pelvic cavity that contains abdominal and pelvic viscera
What are the layers of the pelvic floor?
Endo-pelvic fascia (connective tissue - uterosacrals)
Pelvic diaphragm (levator ani and coccygeus muscle)
Urogenital diaphragm (superficial and deep transverse perineal muscles with fascia covering)
What is Pubocervical fascia?
Provide the support of the anterior vaginal wall
Supports the bladder
Attaches centrally and laterally
What are the 3 Endopelvic support levels?
Level 1 = uterosacral and cardinal ligaments
Level 2 = paravagina to arcus terndineus fascia
Level 3 = Urogenital diaphragm and perineal body
What are the Risk Factors for POP?
Forceps delivery Large baby Prolonged second stage Parity Advancing age Obesity Previous pelvic surgery Hormonal factors Quality of connective tissue Constipation Occupation with heavy lifting Exercise
What are the different Classifications of prolapse
Urethrocele = urethra only Cystocele = bladder Uterovaginal = uterus, cervix and upper vagina Enterocele = upper posterior wall usually with loops of small bowel Rectocele = posterior wall of vagina with rectum forward into the vagina Apical = uterine prolapse
Symptoms in prolapse - Vaginal
Sensation of bulging Seeing a bulge or protrusion Pressure Heaviness Difficulty inserting tampons
Symptoms in prolapse - Urinary
Incontinence Frequency and urgency Weak stream Incomplete emptying Manual reduction of prolapse to complete voiding
Symptoms in prolapse - Bowel
Flatus
Incomplete emptying and straining
Urgency
Digital evacuation
What is used to assess prolapse
Clinical assessment
Exclude pelvic mass
Record position
Baden-walker grading
POPQ score = gold standard (Stage 0 - 4)
What are the investigations of POP?
USS/MRI
Urodynamics
IVU or renal USS
How can you prevent of prolapse?
Avoid constipation Effective management of chronic conditions Smaller family size Pelvic floor muscle training Silicone pessaries of many types
