Pelvic organ prolapse

Question 1

Prolapse

Answer 1

protrusion of an organ or structure beyond its normal anatomical confines

Question 2

Female POP

Answer 2

descent of pelvic organs through or towards vagina

Question 3

% of multiparous and nulliparous women

Answer 3

multi: 12-30% and 2% nulliparous

Question 4

Asymptomatic prolapse

Answer 4

50%

Question 5

Why must abdominopelvic cavity walls be flexible?

Answer 5

accommodate volume and pressure

Question 6

What is the pelvic floor?

Answer 6

The soft tissues that close the space between the pelvic bones

Question 7

What happens if the pelvic floor is normal?

Answer 7

all pelvic viscera in position at rest and with increased intra-abdominal pressure

Question 8

6 dynamic pelvic organs

Answer 8

bladder, uterus, vagina, rectum, anus, urethra

Question 9

3 layers of pelvic floor

Answer 9

endopelvic fascia
pelvic diaphragm
urogenital diaphragm

Question 10

What 3 visceral structures does the endopelvic fascia surround?

Answer 10

uterosacral ligaments
pubocervical fascia
rectovaginal fascia

Question 11

What is endopelvic fascia?

Answer 11

fibromuscular connective type tissue

Question 12

2 muscles in pelvic diaphragm

Answer 12

levator ani and coccygeus

Question 13

Urogenital diaphragm

Answer 13

superficial and deep transverse perineal muscles

Question 14

Significance of fibromuscular connective tissue of endopelvic fascia

Answer 14

fibro-muscular can stretch but connective does not it breaks

Question 15

Medial attachments of uterosacral/cardinal ligaments

Answer 15

cervix, lateral vaginal fornices, uterus, pubocervical and rectovaginal fascia

Question 16

Lateral attachments of uterosacral/cardinal ligaments

Answer 16

sacrum and fascia overlying piriformis muscle

Question 17

Palpation of uterosacral/cardical ligaments

Answer 17

down traction on cervix and if intact allows limited cervix side-side movements

Question 18

Where does uterosacral/cardinal ligaments tend to break?

Answer 18

medially - cervix

Question 19

What is the pubocervical fascia the main support for?

Answer 19

anterior vaginal wall

Question 20

Where does pubocervical fascia tend to break?

Answer 20

lateral attachments or medially in front of cervix

Question 21

Type of tissue that makes up rectovaginal fascia

Answer 21

fibromusculo elastic tissue

Question 22

Upper and lower defects of rectovaginal fascia leads to…

Answer 22

upper - enterocoele

lower - perineal body descent and rectocoele

Question 23

POP risk factors

Answer 23

advancing age - obesity - parity - forceps - big baby- pelvic surgeries - hormonal - hysterectomy - constipation - exercise - heavy lifting

Question 24

urethrocoele

Answer 24

Prolapse of lower anterior vaginal wall involving urethra only

Question 25

cystocoele

Answer 25

Prolapse of upper anterior vaginal wall involving bladder

Question 26

Uterovaginal prolapse

Answer 26

prolapse of uterus, cervix and upper vagina

Question 27

enterocoele

Answer 27

prolapse of upper posterior wall of vagina containing loops of small bowel

Question 28

rectocoele

Answer 28

prolapse of lower posterior vaginal wall involving rectum bulging forwards into vagina

Question 29

vaginal symptoms of POP

Answer 29

``` pressure heaviness sensation of a bulge or protrusion difficult inserting tampons seeing or feeling a bulge or protrusion ```

Question 30

bowel symptoms of POP

Answer 30

splint/push around vagina to start defaecation digital evacuation to complete emptying urgency incomplete emptying or straining incontinence of flatus or liquid/solid stool

Question 31

bladder symptoms of POP

Answer 31

urinary incontinence frequency/urgency weak or prolonged stream/hesitancy manual reduction of prolapse to start or complete emptying

Question 32

Assessment of POP

Answer 32

examine abdomen record position eg left lateral QOL POPQ score

Question 33

3 investigations and use

Answer 33

MRI/USS - levator ani thickness urodynamics - UI or SI IVU or renal USS - suspect ureteric obstruction

Question 34

4 preventions of POP

Answer 34

avoid constipation treat chronic lung disease smaller family size pelvic floor strength exercises

Question 35

PFMT

Answer 35

increase pelvic floor strength for mild prolapse in young women

Question 36

Supplementation of PFMT

Answer 36

perinometer biofeedback vaginal cores electrical stimulation

Question 37

Materials of pessaries

Answer 37

silicone, lucite, rubber, plastic

Question 38

Advantages of silicone pessaries

Answer 38

long shelf life resistance to autoclaving and recurrent cleaning non-absorbent towards secretions and odors inert hypoallergenic

Question 39

vaginal pessaries vs surgery

Answer 39

no real difference

Question 40

Aim of surgical treatment

Answer 40

relieve symptoms restore and maintain bladder and bowel function maintain vaginal capacity for sexual function

Question 41

What to remember in surgical treatment

Answer 41

prophylactic antibiotics and VTE