Pelvic floor prolapse Flashcards
What is prolapse
What is meant be female pelvic organ prolapse?
Protrusion of an organ or structure beyond its normal anatomical confines
Descent of the pelvic organs through the vagina
What are the organs that can be involved in prolapse
What are the three distinct layers of the pelvic floor
Which one is mainly associated with pelvic floor prolapse
Uterues, vagina, rectum,anus, urethra and bladder
Endopelvic fascia (mainly associated with pelvic floor prolapse, doesnt stretch just snaps)
Pelvic diaphragm
Urogenital diaphragm.
Describe the structure of the endopelvic fascia
Network of fibromuscuar connective type tissue that has a hammock like configuration.It is composed of uterosacral ligaments, pubocervical fascia and rectovaginal fascia
Describe the structure of the Pelvic diaphragm
layer of striated muscles with fascial coverings. Comprised of levator ani and coccygeus
Describe the structure of the Urogeintal diaphragm
Anterior layers of fascia that contains the superficial and deep perineal muscles along with their fascia
What are the three weakest points in the endopelvic fascia that tend to break
How do they break?
utero-sacral cardinal complex- tends to break medially at cervix
Pubocervical fascia- provide the main supports of the anterior vaginal wall, tends to break at lateral attachments or immediately in front of the cervix
Rectovaginal fascia- tends to break centrally, if upper defect its an enterocele, if its a lower defect its a rectocele
What are the five different types of pelvic organ prolapse
Urethrocele- prolapse of anterior vaginal wall involving urethra only
Cystocele- prolapse of upper anterior vaginal wall involving the bladder
Uterovaginal prolapse- prolapse of uterus, cervix and upper vagina
Enterocele- proplapse of the upper posterior wall of teh vagina usually containing loops of small bowel
Rectocele- proplaspe of the lower posterior wall of the vagina involving the rectum bulging forwards into the vagina.
What vaginal symptoms may a woman with prolapse have?
sensation of bulge feeling bulge pressure heaviness difficulty inserting tampons vaginal lumps
What urinary sypmtoms may a woman with prolapse have (3)
Incontinence Urgency weak or prolonged stream feeling of incomplete emptying manual reduction of prolapse to void
What bowel symptoms may a woman with prolapse have
Incontinence Straining Incomplete emptying digital evacuation splinting to start defacation
What investigations are carried out if a proplapse is suspected
An ultrasound scan to identify type of prolapse
urodynamics to exclude stress incontinence
renal USS if suspicious of ureteric obstruction
examination- to excluded pelvic mass
QoL assessment
POPQ- severity scoring gold standard. Internet tool
Baden-Walker-Halfawy grading
How do you treat pelvic prolapse with physiotherapy
When would you treat with physiotherapy?
Increase pelvic floor strength
Relieve tension on ligaments
mild prolapse or woman who haven’t completed a family
How do you treat pelvic prolapse with vaginal pessaries?
What are the advantages of treating with a pessary
How does pessary treatment comapre with other treatments?
Insert pessary into the vagina to stop the prolapse
Long shelf life, dont absorb odurs, are hypoallergenic
just as successful as surgery
What is the goal of treatment for a surgical prolapse?
What must be given along side surgery treatment
Relieve syptoms, restore adn maintain bladder and bowel functions as well as mainting vaginal capacity for sexual function
Prophylactic antibiotics and thromboembolic drugs must be given, as well as a catheter
How do you prevent pelvic prolapse from re-occuring
avoid constipation, treat lung disease, have a small family, improve antenatal and intrapartum care.
pelvic floor exercises dont prevent relapse only prevent intial lapse
