Pelvic Organ Prolapse

Question 1

Types of prolapse

Answer 1

Rectocele
Cystocele
Enterocele
Vault

Question 2

Symptoms of prolapse

Answer 2

Feeling of something heavy/dragging
Dysuria
Tenesmus

Backache
Incontinence
Bleeding or discharge
Sexual disturbance

Question 3

Investigations of prolapse

Answer 3

Examination - preferably when bladder and bowel are empty

Sim’s speculum

Question 4

Types of vaginal prolapse (vault)

Answer 4

Degree 1 - vagina prolapse does not reach vaginal opening

Degree 2 - vagina prolapses reaches vaginal opening

Degree 3 - Vaginal prolapse comes out of the vaginal opening

Question 5

Risk factors for prolapse

Answer 5

Increased parity
Age 
Menopause 
Obesity 
Smoking 
Connective tissue disorders
Chronic constipation 
Instrumental delivery

Question 6

What supports the uterus

Answer 6

Uterosacral ligament
Transverse ligament
Round ligament

Question 7

Treatment for prolapse

Answer 7

Pelvic floor exercises and conservative management
Pessaries
Surgery

Question 8

Pelvic organ prolapse

Answer 8

Descent of pelvic organs into the vagina

Question 9

Pathophysiology of pelvic organ prolapse

Answer 9

Weakness and lengthening of the ligaments and muscles surrounding the uterus, rectum and bladder.

Question 10

When do vault prolapses occur

Answer 10

Occurs in women who have had a hysterectomy

Question 11

What causes a rectocoele

Answer 11

Defect in the posterior vaginal wall, allowing the rectum to prolapse forwards into the vagina

Question 12

Symptoms of a rectocele

Answer 12

Constipation
Urinary retention
Palpable lump in the vagina

Question 13

What causes a cystocoele

Answer 13

Defect in the anterior vaginal wall, allowing the bladder to prolapse backwards into the vagina

Question 14

Pelvic organ prolapse quantification (POP-Q) system

Answer 14

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

Question 15

Conservative management of pelvic organ prolapse

Answer 15

Physiotherapy (pelvic floor exercises)

Weight loss

Lifestyle changes for associated stress incontinence - reduced caffeine intake and incontinence pads

Treatment of related symptoms - treat stress incontinence with anticholinergics

Vaginal oestrogen cream

Question 16

When should pessaries be removed and cleaned

Answer 16

Pessaries should be removed and cleaned or changed periodically (e.g. every four months).

Question 17

Cautions with pessaries

Answer 17

They can cause vaginal irritation and erosion over time

Question 18

Complications of pelvic organ prolapse surgery

Answer 18

Pain, bleeding, infection, DVT and risk of anaesthetic

Damage to the bladder or bowel

Recurrence of the prolapse

Altered experience of sex