Chapter 18 Pelvic Organ Prolapse Flashcards
pelvic organ prolapse symptoms
pelvic pressure and discomfort, dyspareunia, difficulty evacuating bowels and bladder, low back discomfort.
pelvic relaxation especially apparent in postmenopausal population. due to
decreased endogenous estrogen, effects of gravity over time, normal age in setting of previous pregnancy and vaginal delivery.
risk factors for POP
advancing age, menopause, parity.
asymptomatic prolapse
can be monitored but does not require any further treatment and expectant management is acceptable.
symptomatic pelvic organ prolapse is essentially a structural problem, and therefore requires therapies that reinforce the lost support to the pelvis. conservative management
exercises to strengthen pelvic floor musculature (Kegel exercises). mechanical support devices (pessaries) may be used to manage prolapse and associated symptoms, or defect may be repaired surgically.
surgical treatment options for POP
anterior and posterior colporrhaphy for cystoceles and rectoceles.
only symptomatic when she is engaged in heavy lifting or particularly strenuous activity. she is morbidly obese and would like to begin a formal weight loss program. curious about management options
pelvic floor exercises, weight loss, or pessary.
29 y.o. g2p1 22 weeks pregnant with reports of pelvic bulge and bothersome pressure. PE reveals cervical prolapse, approaching vaginal introitus. worried that prolapse will worsen as pregnancy progresses. offer..:
pessary trial. counseled regarding removal, cleaning, and maintenance. pt should be followed to monitor for vaginal erosions, lesions, or ulcerations.
occasional small volume stress incontinence with coughing or sneezing, only during her pregnancy.
2ndary to anatomic changes of an expanding uterus in pregnancy, incidence of stress incontinence can be quite high. incontinence resolves after recovery from peripartum period. ANTICHOLINERGIC MEDICATION IS INDICATED FOR URGE INCONTINENCE.
