Pelvic organ prolapse Flashcards
(55 cards)
what is pelvic organ prolapse
downward displacement of one or all pelvic organs from its normal location resulting in Vaginal protrusion or bulge
POP involves herniating what organs?
Bladder Urethra Rectum Uterus Small bowel
why POP is common in menopause
bcoz lack of hormonal support
why POP is related to parity
the more the woman has delivered (esp NSVD) more chance for her to prolapse
components of Levator ani muscles
pubococcygeus
puborectalis
iliococcygeus
innervations of levator ani muscles
pudendal nerve
perineal nerve
inferior rectal nerve
this is utilized as an anchor pt for prolapsed organ in the mgt
sacrospinous ligament
Level I support system for the uterus and vagina
utersacral/cardinal ligament complex, w/c serve to maintain the vaginal lengh and axis
Level II support system for the uterus and vagina
consists of paravaginal attachments of the lateral vagina and endopelvic fascia to the arcus tendineus that maintain the midline position of the vagina
Level III support system for the uterus and vagina
made up muscles and con tis surrounding the distal vagina and perineum
muscle that is most stretched during the 2nd stage of labor that causes direct injury
pubococcygeus
neurologic injury involves injury to the
pudendal nerve
vaginal delivery, chronic straining and w/ defacation in constipation can lead to what kind of injury
neurologic injury (stretching injury to pudendal nerve)
if you want to locate the pudendal nerve this is a good landmark
ischial spine
in identifying the pudendal nerve, after you have located the ischial spine what should you look for next
sacrospinous ligament. there, behind the sacrospinous ligament is the pudendal nerve.
sacropspinous ligament is attached to the ischial spine
mechanisms involved in vaginal wall injury
site specific defects
smooth muscle dysfunction
con tis abnormalities
w/c is worse among the site specific defects
displacement type
in this defect the structure is distorted but the organs are still attached to the pelvic side wall
distention type
in this defect there is loss of con tis attachment of lateral vaginal wall to pelvic side wall
displacement type
this is responsible for the anteflexed position so there is loss of the normally anteflexed or anteverted position of the uterus
round ligament
in this defect there is abnormality in the attachment of lateral vagina to pelvic side wall
smooth muscle dysfxn
vaginal wall injury that causes POP among menopausal women and those with Ehler Danlos and Marfan syndrome
Con tis Abnormalities (less collagen content & con tis d/o)
Risk factors for POP
multiparity Age Race Increased ab pressure Con tis dse
why are caucasians more prone to POP while blacks are less prone
Caucasians usually have gynecoid pelvis which has a wider pubic arch;
blacks have narrow
