8.1. Pelvic Organ Prolapse - Definitions / Epidemiology / Anatomy & Physiology

Question 1

What is the Definition of a Prolapse?

Answer 1

Protrusion of an Organ / Structure beyond its normal Anatomical Confines

Question 2

What is the Definition of a Female Pelvic Organ Prolapse?

Answer 2

Refers to the Descent of the Pelvic Organs Towards / Through the Vagina

Question 3

What is the Prevalence of Female Pelvic Organ Prolapse?

Answer 3

1. 50% of Parous Women will have some Degree of Disease
2. 12-30% of Multiparous Women
3. 2% of Nulliparous Women
   Note - only 10-20% of Parous Women seek medical help

Question 4

What are the Female Pelvic Organs?

Answer 4

1. Uterus
2. Bladder
3. Rectum
4. Anus
5. Vagina

Question 5

What are the 3 Layers of the Female Pelvic Floor?

Answer 5

1. Endo-Pelvic Fascia
2. Pelvic Diaphragm
3. Urogenital Diaphragm

Question 6

What is the Female Endo-Pelvic Fascia?

Answer 6

A Network of Fibro-Muscular (can Stretch) Connective-Type Tissue that has a “Hammock-Like” Configuration and Surrounds the various Visceral Structures:

1. Uterosacral Ligaments
2. Pubocervical Fascia
3. Rectovaginal Fascia

Question 7

What is the Female Pelvic Diaphragm?

Answer 7

A Layer of Striated Muscles with its Fascia Coverings:

1. Levator Ani
2. Coccygeus

Question 8

What is the Female Urogenital Diaphragm?

Answer 8

The Superficial and Deep-Transverse Perineal Muscles with their Fascial Coverings

Question 9

What are the Female Utero-Sacral (Cardinal) Complex attachments?

Answer 9

1. Medially:
2. a) Uterus, Cervix, Lateral Vaginal Fornices
3. b) Pubocervical & Rectovaginal Fascia
4. Laterally:
5. a) Sacrum
6. b) Fascia overlying the Periformis Muscle

Question 10

What is the Function of the Female Utero-Sacral (Cardinal) Complex?

Answer 10

If intact it allows Limited Side-Side Movement of the Cervix

Note - This tends to break Medially (Around the Cervix)

Question 11

What is the function of the Pubocervical Fascia?

Answer 11

It provides the Main Support of the Anterior Vaginal Wall

Question 12

Where is the Female Pubocervical Fascia made of?

Answer 12

Trapezoidal Fibro-Muscular Tissue

Question 13

Where are the Female Pubocervical Fascia attachments?

Answer 13

1. Centrally - Merge with the Base of the Cardinal Ligaments and the Cervix
2. Laterally - Arcus Tendinus and Pascia Pelvis
3. Distally - Urogenital Diaphragm

Question 14

Where does the Pubocervical Fascia tend to break at?

Answer 14

1. Lateral Attachments

2. Immediately in front of the Cervix

Question 15

What is the Rectovaginal Fascia made of?

Answer 15

Fibro-Musculo-Elastic Tissue

Question 16

Where are the Rectovaginal Fascia attachments?

Answer 16

1. Centrally - Merge with the Base of the Utero-Sacral (Cardinal) Ligaments and Peritoneum
2. Laterally - Fuses with the Fascia over the Levator Ani
3. Distally - Firmly to the Perineal Body

Question 17

Where does the Rectovaginal Fascia tend to break?

Answer 17

Centrally:

1. If upper defect - Enterocele
2. If lower defect - Perineal Body Descent & Rectocele

Question 18

What are the 3 Layers of Endo-Pelvic Support?

Answer 18

Level 1 - Utero-Sacral / Cardinal Ligaments
Level 2 - Para-Vagina to Arcus Tendineus Fascia: Pubocervical / Rectovaginal Fascia
Level 3 - Urogenital Diaphragm / Perineal Body