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?
what fascia provides main support for the abdominal wall?
what are the risk factors for pelvic organ prolapse?
> pregnancy and childbirth
- forceps delivery
- large baby
- prolonged second stage
> advancing age
> previous pelvic surgeries (continence procedures)
> quality of the connective tissue
> heavy lifting
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)
> difficulty inserting tampon
what urinary symptoms may prolapse cause?
> feeling of incomplete voiding
> manual reduction of prolapse to void (splinting)
what bowel symptoms may prolapse cause?
> feeling of incomplete emptying
> splinting to defecate
> digital evacuation to complete
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)
> 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)