Incontinence and prolapse Flashcards
What does prolapse mean?
Downward protrusion of hollow organ thorough its introitus or natural opening
What is the different between a prolapse and a hernia?
Hernia is a protrusion through an abnormal opening
3 types of prolapses that can be seen in the vagina and where they come from?
Cystocele from anterior compartment, enterocele from posterior compartment, rectocele from rectum
Denervation of what nerve can lead to prolapse?
pudendal nerve
Disruption to the pelvic floor support can lead to what 2 main symptoms?
Urethral hypermobility and therefore stress incontinence, descent and pelvic organ prolapse
What congenital abnormality is linked to prolapse? what CT disorder can cause pelvic floor disorder?
Spina bifida, Ehlers Danlos
Indirect vs direct trauma in obstetric complications of pelvic floor muscles?
indirect - stretch of the pudendal nerve, direct - tearing of levators or CT fascia
% of women that undergo surgery for pelvic organ prolapse in their lives
10%
Risk factors for POP?
Parity, racial, smoking/resp disease, exercise, occupation, obstetric indirect and direct trauma, spina bifida, obesity
Symptoms of POP?
Feeling of a lump, can feel it dragging down, lower back pain, urinary symptoms of incontinence and urgency, difficulty voiding
3 classifications of POP through the anterior wall?
Cystocele, urethrocele, cystourethrocele
what prolapse will you find at the posterior wall lower half?
Rectocele
What prolapse would you find at the posterior wall upper half?
enterocele
2 prolapses in the middle compartment?
vaginal vault and uterine
3 grades of prolapse?
1 = descend into the vagina 2 = descent to the opening of introitus 3 = descent through the opening of the introitus
what does procidentia mean?
When there is a 4th degree prolapse and the fundus of the uterus passes through the introitus
Non surgical management options of prolapse?
Pessaries, HRT, stop smoking, lose weight, pelvic floor exercises, electrical stimulation
What can occur if pessaries are forgotten about?
Discharge, bleeding, granulation, fistulas, malignant change
Surgical procedure to fix a cystocele?
Anterior colporrhaphy
How do you perform a vault suspension?
Sacrospinous fixation, sacrocolpopexy, sacrohysteropexy
What two forces try and expel urine from the bladder?
intravesical and intra-abdominal pressure
What is the force that prevents expulsion of urine from the bladder?
urethral sphincter pressure
Muscle that predominantly controls the bladder?
Detrusor muscle
What muscle type is the urethral sphincter made from?
striated muscle
