Pelvic organ prolapse Flashcards
(28 cards)
What is pelvic organ prolapse?
Refers to descent of pelvic organs into vagina as a result of weakness & lengthening of the ligaments & muscles surrounding the uterus, rectum and bladder
What is uterine prolapse?
Where the uterus itself descends into the vagina
What is vault prolapse?
Occurs in women who have had a hysterectomy, and no longer have a uterus - top of vagina (vault) descends into vagina
What is a rectocele?
Where rectum prolapses into vagina due to a defect in the posterior vaginal wall
What is rectocele associated with?
Constipation
What may women with rectocele develop?
Faecal loading in the part of the rectum that has prolapsed which can result in significant constipation, urinary retention and a palpable lump in vagina
Women may have to use their fingers to press the lump backwards to correct the position of the rectum to open bowels
What is a cystocele?
Caused by a defect in the anterior vaginal wall, allowing bladder to prolapse backwards into vagina
What is a cystourethrocele?
Prolapse of both bladder and urethra
What are the risk factors for pelvic organ prolapse?
Multiple vaginal deliveries, instrumental, prolonged or traumatic delivery, advanced age & postmenopausal, obesity, chronic respiratory disease causing coughing, chronic constipation causing straining
What are the presentations of pelvic organ prolapse?
A feeling of ‘something coming down’, dragging sensation in pelvis, urinary symptoms - incontinence, urgency, frequency, bowel symptoms - constipation, incontinence, urgency, sexual dysfunction - pain, altered sensation, reduced enjoyment
What should be done before examination for pelvic organ prolapse?
Pt should empty their bladder and bowel before exam
What position should the patient be in during examination?
Dorsal and L lateral position
What is a Sims speculum?
A U shaped, single bladed speculum can be used to support the anterior or posterior vaginal wall whilst the others are examined
How is a rectocele examined?
It’s held on anterior wall to examine for a rectocele
How is a cystocele examined?
On posterior wall = cystocele
What is the grading system for pelvic organ prolapse?
Pelvic organ prolapse quantification (POP-Q) system:
Grade 0 = normal,
Grade 1 = lowest part more than 1cm above the introitus,
Grade 2 = lowest part within 1cm of introitus,
Grade 3 = lowest part more than 1cm below introitus but not fully descended,
Grade 4 = full descent with eversion of vagina
What are the 3 options for management of pelvic organ prolapse?
- Conservative management 2. Vaginal pessary 3. Surgery
What does conservative management include?
Physiotherapy - pelvic floor exercises, weight loss, lifestyle changes - stress incontinence, reduced caffeine intake, incontinence pads, treatment of related symptoms, vaginal oestrogen cream
What are vaginal pessaries?
Inserted into vagina to give extra support to pelvic organs
What is a ring pessary?
Ring shape and sits around cervix, holding uterus up
What are shelf & Gellhorn pessaries?
Flat disc with a stem, that sits below the uterus with the stem pointing downwards
What are cube pessaries?
Cube shaped
What are donut pessaries?
Thick ring, similar to doughnut
What are Hodge pessaries?
Almost rectangular- one side hooks around posterior aspect of cervix and other extends into vagina
