Gynae: urinary incontinence and organ prolapse Flashcards
what is organ prolapse?
descent of pelvic organs into the vagina as a result of weakening and lengthening of the ligaments and muscles surrounding the uterus, rectum and bladder
what is a uterine prolapse?
where the uterus itself descends into the vagina
what is a vault prolapse?
occurs in women that have had a hysterectomy and no longer have a uterus
top of the vagina descends into the vagina
what is a rectocele?
defect in the posterior vaginal wall, allowing the rectum to prolapse forwards into the vagina
can develop faecal loading in the part of the rectum that has prolapsed into the vagina - can cause constipation, urinary retention and a palpable lump in vagina
women may use fingers to press lump backwards correcting anatomical position of the rectum - allows them to open bowels
what is a cystocele?
defect in the anterior vaginal wall allowing bladder to prolapse backwards into the vagina
prolapse of the urethra is possible - urethrocele
prolapse pf both bladder and urethra is cystourethrocele
what are some risk factors for for pelvic organ prolapse?
- Multiple vaginal deliveries
- Instrumental, prolonged or traumatic delivery
- Advanced age and postmenopause status
- Obesity
- Chronic respiratory disease causing coughing
- Chronic constipation causing straining
how does organ prolapse present?
- A feeling of “something coming down” in the vagina
- A dragging or heavy sensation in the pelvis
- Urinary symptoms, such as incontinence, urgency, frequency, weak stream and retention
- Bowel symptoms, such as constipation, incontinence and urgency
- Sexual dysfunction, such as pain, altered sensation and reduced enjoyment
- women may have identified a lump or mass in the vagina and often will already be pushing it back up themselves
- prolapse worse on straining or bearing down
what is seen on examination of an organ prolapse?
ask pt to empty bladder/bowel 1st
various positions - dorsal and left lateral position
Sim’s speculum U shaped, single-bladed speculum that can be used to support anterior or posterior wall while other wall is examined
ask to cough/bear down during assessment
what are the grades of uterine prolapse?
pelvic organ prolapse quantification system
- Grade 0: Normal
- Grade 1: The lowest part is more than 1cm above the introitus
- Grade 2: The lowest part is within 1cm of the introitus (above or below)
- Grade 3: The lowest part is more than 1cm below the introitus, but not fully descended
- Grade 4: Full descent with eversion of the vagina
what is a uterine procidentia?
prolapse extending beyond the introitus
what are the management options for organ prolapse?
conservative
vaginal pessary
surgery
what are the conservative options for pelvic organ prolapse?
appropriate for women that are able to cope with mild symptoms, do not tolerate pessaries or are not suitable for surgery
options are:
- Physiotherapy (pelvic floor exercises)
- Weight loss
- Lifestyle changes for associated stress incontinence, such as reduced caffeine intake and incontinence pads
- Treatment of related symptoms, such as treating stress incontinence with anticholinergic mediations
- Vaginal oestrogen cream
what are vaginal pessaries?
inserted into the vagina to provide extra support to the pelvic organs
often create significant improvement in symptoms and can easily be removed and replaced if they cause any problems
what are the different types of vaginal pessary?
- Ring shape, and sit around the cervix holding the uterus up
- Shelf and Gellhorn - consist of a flat disc with a stem, that sits below the uterus with the stem pointing downwards
- Cube pessaries are a cube shape
- Donut pessaries consist of a thick ring, similar to a doughnut
- Hodge pessaries are almost rectangular. One side is hooked around the posterior aspect of the cervix and the other extends into the vagina.
how often do pessary need to be changed and what can be done to reduce vaginal wall irritation?
removed/changed every 4 months
oestrogen creams help to protect the vaginal walls from irritation
