Pelvic Organ Prolapse

Question 1

What is pelvic organ prolapse

Answer 1

Is downward descent of female pelvic organs including the bladder , uterus

Question 2

Risk factors

Answer 2

Established risk factors: vaginal childbirth, advancing age , increasing body mass index
Potential risk factors: previous hysterectomy, shape or orientation of pelvic bones , family history, race, heavy lifting, constipation, connective tissues disorders
Obstetrics factors: infant birthweights, young age at first delivery

Question 3

Classification of prolapse

Answer 3

Anterior vaginal wall ( anterior compartment)
Posterior vaginal wall ( posterior compartment)
Apical prolapse

Question 4

Anterior vaginal wall

Answer 4

This wall support bladder and urethra, loss of this support result in urethral hyper mobility and cystocele formation which will develop stress urinary incontinence

Urethrocele; a prolapse of urethra ( tube that carries urine)
Cystocele: protrusion of the bladder into the vagina the most common condition

Question 5

Posterior vaginal wall

Answer 5

Rectocele: the rectum bulges into the vagina
Enterocele: the small intestine bulges into the vagina

Question 6

Apical prolapse

Answer 6

It’s the descent of uterus, cervix or vaginal vault

Uterine prolapse: the uterus drop into vagina
Vaginal vault prolapse:

Question 7

Vaginal vault prolapse

Answer 7

condition in which the upper portion of the vagina loses its normal shape and sags or drops down into the vaginal
canal or outside of the vagina. This can occur either in conjunction with uterine prolapse or even after a hysterectomy.

Question 8

Baden- walker half way system

Answer 8

0= normal position
1= descent halfway to the hymen
2= descent to the rymen
3= descent halfway past the hymen
4= maximum possible descent for each site

Question 9

Pelvic organs prolapse quantization systems (POP-Q)

Answer 9

0= No prolapse
I= The most distal portion of the prolapse is >1 cm
above the level of the hymen
II= The most distal portion of the prolapse is <1 cm
above or below the level of the hymen
III= The most distal portion of the prolapse is >1 cm
below the hymen but protrudes no further than
2 cm less than the total vaginal length
IV= Complete eversion of the total length of the
vagina. The distal portion protrudes at least the total
vaginal length minus 2 cm beyond the hymen

Question 10

Symptoms for vaginal

Answer 10

Sensation or seeing / feeling of bulge or protrusion
Pressure/ heaviness

Question 11

Symptoms of urinary

Answer 11

Incontinence
Frequently
Urgency
Weak or prolonged urinary stream
Hesitancy
Feeling of incomplete emptying
Manual reduction of prolapse to start or complete voiding
Position change to start or complete voiding

Question 12

Symptoms of bowel

Answer 12

• Incontinence of flatus, or
liquid or solid stool
• Feeling of incomplete
emptying
• Straining during
defecation
• Urgency to defecate
• Digital evacuation to
complete defecation
• Splinting, or pushing on
or around the vagina or
perineum, to start or
complete defecation
• Feeling of blockage or
obstruction during
defecation

Question 13

Symptoms of sexual

Answer 13

Dyspareunia

Question 14

Assessment

Answer 14

Digital palpation
Perineoment ( vaginal manometer)
Ultrasonography

Question 15

Digital palpation

Answer 15

Modified oxfords scale
Perfect: P= power E= endurance R= repetition F= fast ECT= every contraction timed

Question 16

Perineometer

Answer 16

For measuring strength of voluntary contributions of pelvic floor muscles

Question 17

Ultrasonography

Answer 17

It is used to determine the accuracy of the
muscle contractions, anatomical position of
the muscles and muscle volume.

Question 18

Management of pop

Answer 18

Kegel exercises
Biofeedback
Vaginal cones
Pessaries
Surgeries

Question 19

Surgery obliterative

Answer 19

Is narrow or closes off the vagina to provide support for prolapsed organs
Sexual intercourse is not possible after this surgery

Preferred for stage 3 or 4 pelvic organ prolapse or recurrent pelvic organ prolapse.
Partial Colpocleisis or total colpocleisis

Question 20

Reconstructive surgery

Answer 20

Restore organs to their original position by using native tissue repair

Question 21

Hysterectomy surgery

Answer 21

Most common , is an operation to remove women uterus

Question 22

1: Colporrhaphy
2: Sacrocolpopexy
3: Sacrohysteropexy

Answer 22

1a: Used to treat prolapse of the anterior (front wal of the vagina and prolapse of the posterior (back) wall of the vagina.

2a: Used to treat vaginal vault prolapse and enterocele.

3a: Used to treat uterine prolapse when a woman does not want a hysterectomy.