Organ Prolapse

Question 1

uterine prolapse

Answer 1

uterine herniation into the vag

Question 2

RF for uterine prolapse

Answer 2

weakness of pelvic floor structure (especially traumatic), increased pelvic floor pressure, multiple vag deliveries, obesity, repeated heavy lifting

Question 3

grades 1 UP

Answer 3

descent into upper 2/3 of vag

Question 4

grade 2 up

Answer 4

cervix approaches introitus

Question 5

grade 3 up

Answer 5

outside introitus

Question 6

grade 4 up

Answer 6

entire uterus outside vag (complete prolapse)

Question 7

s/sx of up

Answer 7

pelvic/vag fullness, heaviness with “falling out senstiona”

• lower back pain (especially with prolonged standing)
• vag bleeding, purulent d/c
• urinary frequency, urgency, stress incontinence

Question 8

PE of UP

Answer 8

bulging mass especially with increased intra-abdominal pressure (valsalva)

Question 9

prophylactic tx of UP

Answer 9

• Kegel

- weight control

Question 10

non surgical tx of UP

Answer 10

• pessaries (if perineum can structurally support pessary)

- Estrogen tx (improves atrophy)

Question 11

surgical tx of UP

Answer 11

• hysterectomy

- uterosacral or sacraospinous ligament fixation

Question 12

cystocele

Answer 12

posterior bladder herniating into the anterior vag

Question 13

s/sx of cystocele

Answer 13

leads to “reservoir” effect where the bladder is no completely emptied with the urine is passes

Question 14

rectocele

Answer 14

distal sigmoid colon (rectum) herniates into the posterior distal vag

Question 15

s/scx of rectocele

Answer 15

complain of a sensation of bulging in the vag when they strain on their bowels

Question 16

enerocele?

Answer 16

pouch of douglas (small bowel) herniated into upper vag