Pelvic Organ Prolapse

Question 1

What is a cystocele?

Answer 1

A defect in the anterior vaginal wall that allows the bladder to prolapse backwards into the vagina

Question 2

What is a urethrocele?

Answer 2

A prolapse of the urethra through a defect in the anterior vaginal wall

Question 3

What is a urethrocystocele?

Answer 3

A prolapse of the bladder and urethra through a defect in the anterior vaginal wall

Question 4

What is a uterine prolapse?

Answer 4

Where the uterus prolapses into the vagina

Question 5

What is a rectocele?

Answer 5

Where the rectum prolapses into the vagina through a defect in the posterior vaginal wall

Question 6

What is a vault prolapse?

Answer 6

Only occurs in women that have had a hysterectomy - where the top of the vagina prolapses into the vagina below it

Question 7

Why does prolapse occur?

Answer 7

Weakness and lengthening of the ligaments and muscles surrounding the uterus, rectum and bladder

Question 8

What are the risk factors for genital prolapse?

Answer 8

Multiple vaginal deliveries
Instrumental, prolonged or traumatic delivery
Advanced age - postmenopausal status
Obesity
Chronic respiratory disease resulting in coughing
Chronic constipation - straining

Question 9

What is the presentation of a prolapse?

Answer 9

Feeling of something coming down on the vagina
A dragging sensation in the pelvis
Urinary symptoms
Bowel symptoms
Sexual dysfunction

Question 10

What are the urinary symptoms that prolapse can cause?

Answer 10

Urgency
Frequency
Weak stream
Retention

Question 11

What are the bowel symptoms that prolapse can cause?

Answer 11

Constipation
Incontinence
Urgency

Question 12

What sexual dysfunction symptoms can prolapse cause?

Answer 12

Pain
Altered sensation
Reduced enjoyment

Question 13

What is the grading of a uterine prolapse?

Answer 13

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

Question 14

What are the three management options for prolapse?

Answer 14

Conservative management
Vaginal pessary
Surgery

Question 15

What is involved in conservative management?

Answer 15

Pelvic floor exercises
Weight loss
Reduction of caffeine intake
Incontinence pads
Anticholinergic medications for stress incontinence
Vaginal oestrogen cream

Question 16

What is a vaginal pessary?

Answer 16

A structure inserted into the vagina to provide support to the pelvic organs

Question 17

What types of vaginal pessary exist?

Answer 17

Rings
Shelf
Gellhorn
Cube
Donut
Hodge

Question 18

What does oestrogen cream do for the vagina?

Answer 18

Prevents it from irritation

Question 19

What is the definitive treatment of pelvic organ prolapse?

Answer 19

Surgery - surgical repair of the prolapse, or hysterectomy

Question 20

What are the complications of pelvic organ prolapse surgery?

Answer 20

Pain, bleeding and infection
Damage to the bladder or bowel
Recurrence of prolapse
Altered experience of sex

Question 21

What are the first line investigations for pelvic organ prolapse?

Answer 21

Bimanual palpation for prolapse
Post-void residual urine volume (to check for retention)
Urinalysis