pelvic organ prolapse

Question 1

uterine prolapse

Answer 1

uterus descends into vagina

Question 2

vault prolapse

Answer 2

occurs in women who’ve had hysterectomy

top of vagina (the vault) descends into vagina

Question 3

rectocele

Answer 3

defect in posterior vaginal wall

rectum prolapses forward into vagina

Question 4

cycstocele

Answer 4

defect in anterior vaginal wall

bladder prolapses backwards into vagina

Question 5

urethrocele

Answer 5

prolapse of uerthera

Question 6

risk factors

Answer 6

multiple vaginal deliveries
instrumental, prolonged, traumatic delivery 
advanced age 
postmenopause
obesity 
chronic coughing
constipation

Question 7

presenting symptoms

Answer 7

sensation something coming down 
dragging/heavy sensation 
urinary symptoms 
bowel symptoms 
sexual dysfunction - pain, alt sensation

Question 8

examination

Answer 8

• empty bladder
• identify which wall has defect
• can assess full descent by asking them to bear down

Question 9

scoring system

Answer 9

POP-Q

Question 10

grade 0

Answer 10

normal

Question 11

grade 1

Answer 11

lowest part >1cm above introitus

Question 12

grade 2

Answer 12

lowest part is 1cm within introitus (above or below)

Question 13

grade 3

Answer 13

lowest part is >1cm below introitus but not fully descended

Question 14

grade 4

Answer 14

full descent with eversion of vagina

Question 15

uterine procidentia

Answer 15

prolapse extending beyond introitus

Question 16

3 options for management

Answer 16

conservative
vaginal pessary
surgery

Question 17

when is conservative management appropriate

Answer 17

able to cope with mild symptoms
don’t tolerate pessary
not suitable for surgery

Question 18

conservative management

Answer 18

pelvic floor exercises
weight loss
lifestyle changes
treatment assoc systems e.g. incont
vaginal oestrogen cream

Question 19

vaginal pessary

Answer 19

inserted into vagina to provide extra support to pelvic organs

Question 20

vaginal pessary - follow up/additional measure

Answer 20

should be removed and cleaned every 4months or so

oestrogen cream to help with any vaginal irritation or erosion

Question 21

complications of POP surgery

Answer 21

pain, bleeding, infection 
anaethetic risk 
DVT 
damage to bladder, bowel 
recurrence of POP
alt sex experience