Pelvic Organ Prolapse Flashcards
What is a prolapse?
Protrusion of an organ/structure beyond its normal confines.
Where do female pelvic organs prolapse?
towards or through the vagina
within the vagina
Beyond the vagina
What is a prolapse beyond the vagina called?
Externalisation
What are risk factors of a pelvic organ prolapse?
PARITY - strongest risk Large baby Vaginal deliveries Instrumental births chronic constipation chronic coughing (asthma, COPD) obesity increasing age/menopause Prolonged 2nd stage of labour previous pelvic surgery Fit and thin
What is the cause of pelvic organ prolapse?
A weakness in the pelvic muscles and ligaments
What are the signs and symptoms of a pelvic organ prolapse?
Worse when bearing down
sex - pain or reduced pleasure
urinary - stream, urgency, incontinence, retention
bowel - urgency, constipation
What are the 3 layers of the pelvic floor?
Endo-pelvic fascia = fibro-muscular (muscular part can be trained)
Pelvic diaphragm = striated muscles
Urogenital diaphragm = the perineal muscles and fascia
What is the main muscle of the pelvic floor?
Levator Ani
Which ligament holds the uterus and cervix up?
Utero-sacral ligament
Which fascia holds the bladder and vagina in place?
Pubocervical fascia
What fascia holds the rectum and vagina in place?
Rectovaginal fascia
What fascia holds the rectum and vagina in place?
Rectovaginal fascia
What can cause an anterior vaginal prolapse?
Cystocoele - bladder
urethrocoele - urethra
cystourethrocoele - Bladder and urethra
What can cause a posterior vaginal prolapse?
Rectocoele - rectum
Enterocoele - small intestines
What causes an apical vaignal prolapse?
Prolapse of uterus, cervix and vagina
Hysterectomy
What is an apical prolapse?
Prolapse of uterus, cervix and vagina
Hysterectomy
What are vaginal prolapse symptoms?
Sense of bulge can't insert tampons pressure heaviness painful sex
What are urinary prolapse symptoms?
Incontinence frequency urgency poor stream retention
Manual reduction of prolapse improves stream
What are rectal prolapse symptoms?
incontinence change in stool consistency difficulty cleaning incomplete emptying urgency
What 2 types of assessment are used in pelvic organ prolapse?
POPQ = gold standard
Baden walker
POPQ - pelvic organ prolapse quantification
- shows how severe he prolapse is
What are the investigations for pelvic organ prolapse?
NONE - clinical diagnosis.
Investigations are for associated symptoms only.
What is the treatment of POP stage 1 and 2 (Milder)?
Physiotherapy - pelvic floor muscle training
NOT used in severe cases (stage 3 and 4 where prolapse is outside the vagina)
Pessaries
What is the treatment of POP stage 1 and 2 (Milder)?
Physiotherapy - pelvic floor muscle training
NOT used in severe cases (stage 3 and 4 where prolapse is outside the vagina)
Pessaries
Which pessary is most compatible with sex?
Ring pessary - most commonly inserted by the GP.
Silicone based pessaries are used today.
There is equal satisfaction of pessaries vs surgery.
What type of surgeries can be done for pelvic organ prolapse?
Anterior vaginal wall repair
Posterior vaginal wall repair
Hysterectomy
Hysteropexy (surgical fixation of displaced uterus)
Colpocleisis (vaginal closure, only if no more sex)
Sacrospinous fixation
How many people does POP affect?
50% of multiparous women, 10% have symptoms.
