Utero-vaginal prolapse Flashcards
What is vault prolaps
Top of vagina descends into vagina
IN women with a hysterectomy
What causes rectocele
Defect in posterior vaginal wall, allows rectum to prolapse into vagina
What are rectoceles esp ass with
Constipation
What causes constipation, urinary retention and palpale lump in vagina in rectocele
Faecal loading in part of rectum prolapsed into vagina
Often press lump to return so can pass
What is a cystocele/urothrocele
Bladder prolapse through vagina due to defect in anterior vaginal wall
Urethrocele - urethra prolapses
Can get both together
Risk factors pelvic organ prolapse
Result of weak and stretched muscles and ligaments
-Multiple vaginal deliveries
Instrumental, prolonged or traumatic delivery
Advanced age and postmenopause status
Obesity
Chronic respiratory disease causing coughiing
Chronic constipation -> straining
Presenting symtpoms of pelvic organ prolapse
Something coming down vagina
Dragging or heavy sensation pelvis
Urinary sumptoms - incontinece, urgency, frequency, weak stream and retention
Bowel symptoms eg constipation, incontinence and urgency
Sexual dysfunction eg pain, altered sensation, reduced enjoyment
Examination prep
Empty bowel or bladder
Dorsal or left lateral postiion but easiest one to view prolapse
What speculum is used in examination for prolapse
U shaped, single bladed speculum used to support anterior or posterior vaginal wall while other vaginal walls examined
Anterior wall held - recotcele
Posterior wall held - cystocele
Ask to cough or bear down
Grades of uterine prolapse
0 - normal
I - lowest part>1cm above introitus
2 - within 1cm of introitus above or belwo
3 - >1cm below introitus but not fully descended
4 - full descent with eversion of vagina
What is a uterine procidentia
Prolapse extending beyond introitus
What is a uterine procidentia
Prolapse extending beyond introitus
Options for management of prolapse
Conservative management
Vaginal pesary
Surgery
When is conservative managemetn appropriate for prolapse
Women able to cope with mild symtpoms, dont tolerate pessaries or unsuitbale for surgery
What is conservatiev management for prolapse
Ring pessaries - sit around cervix hold uterus up
Shelf and gellhorn pessaires - flat disc with stem, sit below uterus with stem up
Cube
Donut - thick ring
Hodge 0 recatngular - hooked round posterior aspect of cervix and extends into vagina
