Pelvic Organ prolapse Flashcards
(26 cards)
What is the defintion of prolapse?
Protrusion of an organ or structure beyond its normal anatomical confines
What is the defintion of female pelvic organ prolapse?
Refers to the descent of the pelvic organs towards or through the vagina
What is a urethrocele?
Prolapse of the lower anterior vaginal wall involving the urethra only
What is a cystocele?
Prolapse of the upper anterior vaginal wall involving the bladder
What is a rectocele?
Prolapse of the lower posterior wall of the vagina involving the rectum bulging forwards into the vagina
What is an enterocele?
Prolapse of the upper posterior wall of the vagina usually containing loops of small bowel
What is a uterovaginal prolapse?
This term is used to describe prolapse of the uterus, cervix and upper vagina
What are risk factors for the development of pelvic organ prolapse?
- Pregnancy and labour related issues - Large baby (>4500 gms), Prolonged Second stage, Forceps delivery, Parity
- Advanced Age
- Obesity
- Previous Pelvic Procedures
- Continence procedures - Burch culposuspension, Hysterectomy
- Hormonal Factors
- Quality of Connective Tissue
- Increased IAP - Constipation, chronic coughing
- Occupation with Heavy Lifting
- Exercise - Weight Lifting, High Impact
What are general symptoms of pelvic organ prolapse?
- Dragging sensation/Something coming down
-
Depending on site of prolapse
- Cystitis
- Frequency
- Stress incontinence
- Difficulty defecating
What are symptoms of vaginal prolapse?
- Sensation of a bulge or protrusion
- Seeing or feeling a bulge or protrusion
- Pressure
- Heaviness
- Difficulty in inserting tampons
- Dysparuenia
What are symptoms of a rectocele/Enterocele?
- Incontinence of flatus, or liquid or solid stool
- Feeling of incomplete emptying/ Straining
- Urgency
- Digital evacuation to complete defecation
- Splinting, or pushing on or around the vagina or perineum, to start or complete defecation
How would you examine someone with symptoms of a prolapse?
Left lateral side with Sim’s speculum - ask the patient to bear down
What investigations would you consider doing in a woman with pelvic organ prolapse?
- Bedside - Dipstick
- Bloods - none
- Imaging - Bladder scan, IVU/renal USS
- Other - urodynamics
What is the POPQ scoring system?
Pelvic organs prolapse quantification (POP-Q) is a standardised tool for documenting the examination findings
What is stage 0 POPQ prolapse?
No prolapse
What is stage 1 POPQ prolapse?
Most distal portion of the prolapse is >1cm proximal to the level of the hymen
What is stage 2 POPQ prolapse?
Most distal portion of the prolapse is < 1cm proximal or distal to the level of the hymen
What is stage III POPQ prolapse?
Most distal portion of the prolapse is > 1cm beyond the hymen but protrudes no further than total length of the vagina
What is stage IV POPQ prolapse?
Complete vaginal eversion
What measures can be taken to prevent pelvic organ prolapse?
- Avoid constipation
- Manage chronic chest pathology more effectively
- Lower parity
- Improved intrapartum/antenatal care
- Pelvic floor exercises
Why might you do Renal USS scan in someone with a POP?
Look for signs of ureteric obstructions
What conservative measures could you use to manage POP?
- Preventative measures - alter exercise, reduce weight etc.
- Physiotherapy - Pelvic floor muscle training
What medical interventions can be used to manage pelvic organ prolapse?
- Ring Pessaries
- Oestrogen cream
What is the main purpose of surgical intervention in someone with POP?
- Relieve symptoms
- Restore bladder/Bowel function
- Maintian vaginal capacity for sexual function
