Benign Disorders of Reproductive Tract Flashcards
Pelvic Organ Prolapse (POP)
the abnormal decent or herniation of the pelvic organs from their original attachment sites or normal position in the pelvis
Pelvic Support Disorders
Pelvic organ prolapse
Urinary and Fecal Incontinence
-cause significant physical and psychological morbidity
What causes pelvic support disorders?
weakening of the connective tissue and muscular support of pelvic organs due to a number of factors:
- vaginal childbirth
- age
- heavy work
- poor nutrition
- increasing body mass
What are the 4 types of Pelvic Organ Prolapse?
- Cystocele
- Rectocele
- Enterocele
- Uterine Prolapse
Cystocele
occurs when the posterior bladder wall protrudes downward through the anterior vaginal wall
Rectocele
occurs when the rectum sags and pushes against or into the posterior vaginal wall
Enterocele
when the small intestine bulges through the posterior vaginal wall (straining)
Uterine prolapse
the uterus descends through the pelvic floor and into the vaginal canal
Stages of Pelvic Organ Prolapse
Stages 0-4
Stage 0
NO descent of pelvic structure during straining
Stage 1
prolapsed descending organ is > 1 cm above the hymenal ring
Stage 2
prolapsed organ extends 1 cm below the hymenal ring
Stage 3
prolapsed organ extends 2-3 cm below the hymenal ring
Stage 4
the vagina is completely everted or the prolapsed organ is > 3 cm below the hymenal ring
Risk factors for Pelvic Organ Prolapse
- constant downward gravity
- atrophy of supporting tissues b/c aging
- childbirth trauma
- reproductive surgery (hysterectomy)
- family history
- young age at first birth
- connective tissue disorders
- straining
- obesity
Symptoms of Pelvic Organ Prolapse
- feeling of dragging, a lump in the vagina, or something “coming down”
- vaginal bulging
- pelvic pressure
- difficulty defecating
- stress/urge incontinence
Therapeutic Management for POP
- Kegel exercises
- Hormone replacement therapy
- Dietary and lifestyle modifications
- Pessaries Colpexin Sphere
- Surgery
Vaginal Pessaries
synthetic devices inserted into the vagina to provide support to the bladder and other pelvic organs as a corrective measure
What type of individuals would be recommended to use Pessaries rather than surgery?
- Elderly clients
- Woman who wish to have more children
- Woman who prefer it over surgery
Surgical Options for POP
- Anterior or posterior colporrhaphy (cystocele/rectocele)
- Vaginal Hysterectomy (uterine)
What to look for on physical examination for POP
Pelvic exam for any obvious protrusions and bladder function
Diagnostic tests for POP
urinalysis, ultrasound, urine culture, postvoid urine volume
What are the most common types of urinary incontinence?
Urge, stressed, and mixed
Management of Urge Incontinence
- Kegel exercises
- Pessary ring
- Pharmacotherapy-Anticholinergics
- Surgery if all else fails