Pelvic Organ Prolapse Flashcards
What is a cystocele?
A defect in the anterior vaginal wall that allows the bladder to prolapse backwards into the vagina
What is a urethrocele?
A prolapse of the urethra through a defect in the anterior vaginal wall
What is a urethrocystocele?
A prolapse of the bladder and urethra through a defect in the anterior vaginal wall
What is a uterine prolapse?
Where the uterus prolapses into the vagina
What is a rectocele?
Where the rectum prolapses into the vagina through a defect in the posterior vaginal wall
What is a vault prolapse?
Only occurs in women that have had a hysterectomy - where the top of the vagina prolapses into the vagina below it
Why does prolapse occur?
Weakness and lengthening of the ligaments and muscles surrounding the uterus, rectum and bladder
What are the risk factors for genital prolapse?
Multiple vaginal deliveries
Instrumental, prolonged or traumatic delivery
Advanced age - postmenopausal status
Obesity
Chronic respiratory disease resulting in coughing
Chronic constipation - straining
What is the presentation of a prolapse?
Feeling of something coming down on the vagina
A dragging sensation in the pelvis
Urinary symptoms
Bowel symptoms
Sexual dysfunction
What are the urinary symptoms that prolapse can cause?
Urgency
Frequency
Weak stream
Retention
What are the bowel symptoms that prolapse can cause?
Constipation
Incontinence
Urgency
What sexual dysfunction symptoms can prolapse cause?
Pain
Altered sensation
Reduced enjoyment
What is the grading of a uterine prolapse?
Grade 0 - Normal
Grade 1 - prolapse is more than 1cm above the introitus
Grade 2 - prolapse is within 1cm of the introitus
Grade 3 - prolapse is more than 1cm below the introitus, but not fully descended
Grade 4 - full descent with eversion of the vagina
What are the three management options for prolapse?
Conservative management
Vaginal pessary
Surgery
What is involved in conservative management?
Pelvic floor exercises
Weight loss
Reduction of caffeine intake
Incontinence pads
Anticholinergic medications for stress incontinence
Vaginal oestrogen cream
What is a vaginal pessary?
A structure inserted into the vagina to provide support to the pelvic organs
What types of vaginal pessary exist?
Rings
Shelf
Gellhorn
Cube
Donut
Hodge
What does oestrogen cream do for the vagina?
Prevents it from irritation
What is the definitive treatment of pelvic organ prolapse?
Surgery - surgical repair of the prolapse, or hysterectomy
What are the complications of pelvic organ prolapse surgery?
Pain, bleeding and infection
Damage to the bladder or bowel
Recurrence of prolapse
Altered experience of sex
What are the first line investigations for pelvic organ prolapse?
Bimanual palpation for prolapse
Post-void residual urine volume (to check for retention)
Urinalysis
