pelvic organ prolapse Flashcards
what is prolapse?
Prolapse – weakness and lengthening of ligaments and muscles surrounding muscles around uterus, rectum and bladder
what is uterus prolapse?
uterus descends into vagina
what is vault prolapse?
Vault prolapse: occurs in woman who have had a hysterectomy and no longer have a uterus top of vagina descends into vagina
what is a rectocele?
Rectocele: defect in posterior vaginal wall and rectum prolapses forwards into vagina
what are signs of rectoceles?
- Signs: faecal loading – constipation, urinary retention and palpable lumps
- May have to push lump in order to defecate
what is a cystocele?
Cystocele: caused by defect in anterior vaginal wall – bladder prolapses back into vagina
what complication can arise from cystocele?
- Can prolapse into urethra (urethrocele)
what are RF for organ prolapse?
- Multiple vaginal deliveries
- Instrumental, prolonged, traumatic births
- Advanced age/ post-menopause status
- Obesity
- Chronic resp disease – coughing
- Chronic constipation – straining
how does pelvic organ prolapse present?
- Feeling of something coming down within vagina
- Dragging or heavy sensation within pelvis
- Urinary: incontinence, urgency weak stream, retention
- Bowel: constipation, incontinence, urgency
- Sexual dysfunction: pain, altered sensation, reduced enjoyment
what should be done prior to examination?
ideally empty bowel/ bladder prior
what examination should be done for pelvic organ prolapse?
- Sims speculum: U shaped, single bladed speculum that can support anterior or posterior wall while examination other asked to cough to see descent of prolapse
how many grades of PO - prolapse?
4
what is grade 0 in uterine prolapse?
- Grade 0: normal
what is grade 1 in uterine prolapse?
- Grade 1: lowest part is more than 1cm above introitus
what is grade 2 within uterine prolapse?
- Grade 2: lowest part is within 1cm of introitus
what is grade 3 within uterine prolapse?
- Grade 3: lowest part is more than 1cm below introitus but not fully descended
what is grade 4 of uterine prolapse?
- Grade 4: full descent with eversion of vagina
what is uterine procidentia?
prolapse extending beyond introitus
what is the introitus?
external opening of vaginal canal
when would conservative management be appropriate within pop?
Conservative: if can cope with mild symptoms, do not tolerate pessaries, not surgically suitable
what are the conservative management options for pop?
- Physio (pelvic floor exercises)
- Weight loss
- Lifestyle: anything stress incontinence linked (reduce caffeine, incontinence pads)
- Treatment of related symptoms: stress incontinence with anticholinergic (oxybutulin)
- Vaginal oestrogen cream
what is the role of vaginal pessaries within pop?
Vaginal pessaries: can be inserted into vagina for extra support to pelvic organs
what are the different types of pessaries?
- Ring: sit around cervix and hold uterus up
- Shelf and Gellhorn: pessaries consist of flat disc with stem – sit below uterus with stem pointing down
- Cube
- Donut: like a thick ring
- Hodge: pessaries are almost rectangular one side is hooked around posterior aspect of cervix and other extends into vagina
how often should a pessary for pop be removed?
- Should be removed and cleaned every 4mths
