pelvic organ prolapse Flashcards
uterine prolapse
uterus descends into vagina
vault prolapse
occurs in women who’ve had hysterectomy
top of vagina (the vault) descends into vagina
rectocele
defect in posterior vaginal wall
rectum prolapses forward into vagina
cycstocele
defect in anterior vaginal wall
bladder prolapses backwards into vagina
urethrocele
prolapse of uerthera
risk factors
multiple vaginal deliveries instrumental, prolonged, traumatic delivery advanced age postmenopause obesity chronic coughing constipation
presenting symptoms
sensation something coming down dragging/heavy sensation urinary symptoms bowel symptoms sexual dysfunction - pain, alt sensation
examination
- empty bladder
- identify which wall has defect
- can assess full descent by asking them to bear down
scoring system
POP-Q
grade 0
normal
grade 1
lowest part >1cm above introitus
grade 2
lowest part is 1cm within introitus (above or below)
grade 3
lowest part is >1cm below introitus but not fully descended
grade 4
full descent with eversion of vagina
uterine procidentia
prolapse extending beyond introitus
3 options for management
conservative
vaginal pessary
surgery
when is conservative management appropriate
able to cope with mild symptoms
don’t tolerate pessary
not suitable for surgery
conservative management
pelvic floor exercises weight loss lifestyle changes treatment assoc systems e.g. incont vaginal oestrogen cream
vaginal pessary
inserted into vagina to provide extra support to pelvic organs
vaginal pessary - follow up/additional measure
should be removed and cleaned every 4months or so
oestrogen cream to help with any vaginal irritation or erosion
complications of POP surgery
pain, bleeding, infection anaethetic risk DVT damage to bladder, bowel recurrence of POP alt sex experience
