Pelvic Organ Prolapse Flashcards
(16 cards)
Female pelvic organ prolapse
Refers to the descent of the pelvic organs towards or through the vagina.
What are the three layers of the pelvic floor?
- Endo-pelvic fascia
- Pelvic Diaphragm
- Urogenital Diaphragm
Risk factors for pelvic organ prolapse
- pregnancy and vaginal birth
- advancing age
- obesity
- continence procedure
- hysterectomy
- constipation
- Weight lifting, high-impact aerobics and long-distance running
Factors during birth that increase risk of pelvic organ prolapse
- Forceps Delivery
- Large baby (> 4500 gm)
- Prolonged Second Stage
Traditional classification of prolapse
- Urethrocele: Prolapse of the lower anterior vaginal wall involving the urethra only.
- Cystocele: Prolapse of the upper anterior vaginal wall involving the bladder.
- Uterovaginal prolapse. This term is used to describe prolapse of the uterus, cervix and upper vagina.
- Enterocele: Prolapse of the upper posterior wall of the vagina usually containing loops of small bowel
- Rectocele: Prolapse of the lower posterior wall of the vagina involving the rectum bulging forwards into the vagina.
Typical symptoms in women with pelvic organ prolapse - Vaginal
- Sensation of a bulge or protrusion
- Seeing or feeling a bulge or protrusion
- Pressure
- Heaviness
- Difficulty in inserting tampons
Typical symptoms in women with pelvic organ prolapse – Urinary
- Urinary Incontinence
- Frequency/ Urgency
- Weak or prolonged urinary stream/ Feeling of incomplete emptying
- Manual reduction of prolapse to start or complete voiding
Typical symptoms in women with pelvic organ prolapse – Bowel
- Incontinence of flatus, or liquid or solid stool
- Feeling of incomplete emptying/ Straining
- Urgency
- Digital evacuation to complete defecation
- Pushing on or around the vagina or perineum, to start or complete defecation
Assessment of pelvic organ prolapse
- Examination to exclude pelvic mass
- Record the position of examination: left lateral Vs Lithotomy Vs Standing.
- Quality of Life
- POPQ score
Pelvic organ prolapse investigations
- Urodynamics: concurrent UI or to exclude Occult SI
- IVU or Renal USS (if suspicion of ureteric obstruction)
Pelvic organ prolapse prevention
- Avoid constipation.
- Effective management chronic chest pathology (COPD & asthma).
- Antenatal and post-natal pelvic floor muscle training
Incidence of pelvic organ prolapse
Affects 50% of multiparous women with 10% symptomatic
Treatment types for pelvic organ prolapse.
- physiotherapy
- vaginal pessaries
- surgery
Pelvic floor muscle training
- Increase the pelvic floor strength & bulk and relieves the tension on the ligaments in cases of mild prolapse.
- Appropriate for younger women who have not yet completed their family.
- No role in advanced cases.
- Cannot treat fascial defects.
Advantages of silicone pesseries
- Long Shelf-life
- Resistance to autoclaving and repeated cleaning
- Non-absorbent towards secretions and odors
- Inertness
- Hypoallergenic nature
Aims of surgical treatment of pelvic organ prolapse.
- Relieve symptoms
- Restore/maintain bladder & bowel function
- Maintain vaginal capacity for sexual function
