Pelvic Organ Prolapse Flashcards
What is Level I of the endopelvic support comprised of?
Utero-sacral ligaments, cardinal ligaments
What is Level II of the endopelvic support comprised of?
Pubocervial/rectovaginal fascia
What is Level III of the endopelvic support comprised of?
Urogenital diaphragm
Perineal body
What are the risk factors for pelvic organ prolapse?
Pregnancy/vaginal delivery Age Obesity Previous pelvic surgery Hormone issue Weakened connective tissue Constipation Heavy lifting Exercise
What is a utherocoele?
Urethral prolapse. Lower anterior vaginal wall weakened.
What is a cystocoele?
Bladder prolapse. Upper anterior vaginal wall weakened.
What is uterovaginal prolapse?
Prolapse of the uterus, cervix and upper vagina.
What is a enterocoele?
Small bowel prolapse. Upper posterior vaginal wall weakened.
What is a rectocoele?
Rectal prolapse. Lower posterior vaginal wall weakened.
What are the vaginal symptoms of POP?
Feeling/seeing a lump/bulge
Pressure
Heaviness
Difficulty inserting tampons
What are the urinary symptoms of POP?
Urinary incontinence
Frequency/urgency
Weak/prolonged urinary stream
Having to manually reduce prolapse to empty bladder
What are the bowel symptoms of POP?
Frequency/incontinence of flatus or stool
Incomplete emptying
Having to manually manipulate prolapse to empty bowels
What is the investigation for POP?
Bimanual or speculum examination
USS/MRI
Urodynamic studies
IVU or Renal imaging
What is the prevention for POP?
Avoid constipation
Smaller family size
More education - e.g. pelvic floor exercises
What is the treatment of POP?
Pelvic floor exercises - no role in advanced disease
Education - perinometer, biofeedback, vaginal cones, electric stimulation
Pessary - silicone, just as effective as surgery
Surgery - relieve symptoms and maintain function
A 58 y/o female comes in presenting with “feeling a lump in her vagina”. She often has to “push aside” this lump in order to empty her bladder. What treatment would you advise for her?
Silicon pessary
Potentially surgical management
What is Stage 0 for POP?
No prolapse
What is Stage 1 for POP?
Prolapse >1cm proximal from hymen
What is Stage 2 for POP?
Prolapse <1cm proximal/distal from hymen
What is Stage 3 for POP?
Prolapse <1cm distal to hymen but >2cm away from the total length of vagina.
What is Stage 4 for POP?
Total eversion of the vagina
A 58 y/o female comes in presenting with “feeling a lump in her vagina”. She often has to “push aside” this lump in order to empty her bladder. What treatment would you advise for her?
Silicon pessary
Potentially surgical management
