Genital Prolapse

Question 1

What is it?

Causes - 2

Answer 1

Pelvic organs sag within the vagina due to weakness of supporting structures

Childbirth (commonest) - lack of postnatal kegels
Congenital defects

Question 2

Triggers or exacerbating factors:

• What stage of a woman reproductive life could this happen in?
• Increased intra-abdo pressure could also trigger it. Give examples of things that can cause this?
• What is another lifestyle factor that could contribute to this?

Answer 2

Menopause

Coughing - chronic
Straining - weightlifting
Obesity

Smoking

Question 3

Types of prolapse:

Apical (uterine) prolapse - what is it?

Anterior wall prolapse:

• Cystocele
• Urethrocele

Why might these 2 prolapses cause frequency and reduced emptying?

What symptoms do these 2 types of prolapse cause? - 2

Answer 3

Protrusion of cervix, uterus, or vaginal vault - look up

Protrusion of bladder into her vagina.

The prolapse of the female urethra into the vagina. The weakening of the tissues that hold the urethra in place may cause it to protrude into the vagina.

Residual urine in the cystocele

Incontinence or dysuria

Question 4

Posterior wall prolapse:

• Rectocele
• Sigmoidcele
• Enterocele

What might they have to do to a rectocele to defecate?

Why do they get constipation and difficulty defecating?

Why do they get incontinence?

Answer 4

Protrusion of rectum into her vagina.

Protrusion of sigmoid colon into her vagina.

Reduce herniation with finger PV
—-
Bulge into the vagina effectively diverts the material in the rectum away from the anus

The loss of anatomical support of the rectum may result in various degrees of prolapse and rectoceles resulting in ineffective or obstructive defecation and may present as symptoms of faecal seepage and faecal incontinence.

Question 5

S+S:

What sort of sensation do they feel?

What may they feel down below?

Answer 5

Dragging sensation

Feel bulge down below

Question 6

What is used to grade the degree of the prolapse?

Answer 6

POP-Q - Pelvic Organ Prolapse Quantification

Question 7

Examination:

What positions should the patient be examined in? - 2

What type of speculum should be used?

What can be done to make the prolapse more pronounced if it is difficult to see?

Answer 7

Left lateral position or lithotomy position

Sims speculum

Ask the patient to cough or strain

Question 8

Management:

Conservative - Lifestyle:

• The main advice for most patients
• What should be avoided?
• What should be treated and prevented?
• What can be done to strengthen the muscles?

Answer 8

Weight loss
Avoid heavy lifting
Prevent and Rx constipation
Pelvic floor exercises

Question 9

Management:

Medications and devices:
- What can be prescribed for PM women with vaginal atrophy?
Pessaries:
- Who are they good for?
- How often should they be changed?
- What may they affect?

Answer 9

Vaginal oestrogen (cream, tablet, or ring)

Those unfit or unwilling to undergo surgery

Every 6 months

Sex

Question 10

Management - Surgery:

Indications

Aim of surgery

Why may affect sexual function?

Mesh - why is it used but what is the catch?

Answer 10

Severe symptoms and failure of non-surgical treatment

Excises redundant tissue and strengthens supports

Reduced vaginal width caused by these surgeries

Improves the effectiveness of surgery but has more complications