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Flashcards in Pelvic Organ Prolapse Deck (13):

what are the three distinct layers of the pelvic floor?

> pelvic diaphragm (striated muscle)
> endopelvic fascia (network of fibro-muscular connective tissue)
> urogenital diaphragm (superficial and deep transverse perineal muscles with fascial coverings)


what fascia make up the pelvic floor?

> uterosacral ligaments
> pubocervical fascia
> rectovaginal fascia


what muscle does the uterosacral fascia cover?

the piriformis


what fascia provides main support for the abdominal wall?

pubocervical fascia


what are the risk factors for pelvic organ prolapse?

> pregnancy and childbirth
- forceps delivery
- large baby
- prolonged second stage
> advancing age
> obesity
> previous pelvic surgeries (continence procedures)
> quality of the connective tissue
> heavy lifting
> constipation
> exercise


what different classifications are there for pelvic wall prolapse?

> posterior wall prolapse
> anterior wall prolapse (bladder or urethra)
> atypical prolapse (upper wall of vagina)


what vaginal symptoms can prolapse cause?

> sensation of bulge (seeing protrusion)
> pressure
> heaviness
> difficulty inserting tampon


what urinary symptoms may prolapse cause?

> urgency
> incontinence
> frequency
> hesitancy
> feeling of incomplete voiding
> manual reduction of prolapse to void (splinting)


what bowel symptoms may prolapse cause?

> incontinence
> urgency
> feeling of incomplete emptying
> splinting to defecate
> digital evacuation to complete
> straining


what objective grading scores are there in pelvic organ prolapse?

> Braden walker halfway grading
> POPQ score


what investigations can you carry out in pelvic organ prolapse?

> USS/MRI (identify fascial defects)
> urodynamics
> IVU/ renal USS (exclude uretic obstruction)


how can pelvic organ prolapse be prevented?

> avoid constipation
> manage chronic chest pathology
> smaller family size
> improve antenatal and intrapartum care (pelvic floor training exercises)


what management options are there for pelvic organ prolapse?

> silicone pessaries
> surgery aiming to relieve symptoms, restore bowel and bladder function and maintain vaginal capacity for sex