Pelvic Organ Prolapse

Question 1

What is a vault prolapse?

Answer 1

Occurs in women that have had a hysterectomy, and no longer have a uterus. The top of the vagina (the vault) descends into the vagina.

Question 2

List 6 factors that can contribute to pelvic organ prolapse.

Answer 2

1. Multiple vaginal deliveries
2. Instrumental, prolonged or traumatic delivery
3. Advanced age and postmenopause status
4. Obesity
5. Chronic respiratory disease causing coughing
6. Chronic constipation causing straining

Question 3

What are typical presenting symptoms of pelvic organ prolapse?

Answer 3

1. A feeling of “something coming down” in the vagina
2. A dragging or heavy sensation in the pelvis
3. Urinary symptoms, such as incontinence, urgency, frequency, weak stream and retention
4. Bowel symptoms, such as constipation, incontinence and urgency
5. Sexual dysfunction, such as pain, altered sensation and reduced enjoyment
6. Women may have identified a lump or mass in the vagina, and often will already be pushing it back up themselves. They may notice the prolapse will become worse on straining or bearing down.

Question 4

What is a Sim’s speculum?

Answer 4

U-shaped, single-bladed speculum that can be used to support the anterior or posterior vaginal wall while the other vaginal walls are examined.

Question 5

What is the pelvic organ prolapse quanitification (POP-Q) system?

Answer 5

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 6

What term describes a prolapse extending beyond the introitus?

Answer 6

Uterine procidentia

Question 7

What are the 3 options for management of pelvic organ prolapse?

Answer 7

1. Conservative management
2. Vaginal pessary
3. Surgery

Question 8

List 5 conservative management options.

Answer 8

1. Pelvic physiotherapy
2. Weight loss
3. Lifestyle changes for SUI (reduced caffeine intake and incontinence pads)
4. Treatment of related symptoms (anticholinergics for SUI)
5. Vaginal oestrogen cream

Question 9

How often should pessaries be changed?

Answer 9

Every 4 months.

Question 10

What can pessaries cause over time? How can this be managed?

Answer 10

Vaginal irritation and erosion over time. Oestrogen cream helps protect the vaginal walls from irritation.