Pelvic organ prolapse Flashcards
What is pelvic organ prolapse?
the descent of pelvic organs into the vagina.
What causes pelvic organ prolapse?
Weakness and lengthening of the ligaments and muscles surrounding the uterus, rectum and bladder
What are the 4 main forms of pelvic organ prolapse?
Uterine prolapse
Vault prolapse
Rectocele (Rectum)
Cystocele (Bladder)
What is uterine prolapse?
The uterus itself descends into the vagina.
What is vault prolapse?
Vault prolapse 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.
What is rectocele?
Rectoceles are caused by a defect in theposterior vaginal wall, allowing the rectum to prolapse forwards into the vagina.
What are cystoceles?
Cystoceles are caused by a defect in theanterior vaginal wall, allowing the bladder to prolapse backwards into the vagina.
What is a urethrocele?
Prolapse of the urethra
What is a cystourethrocele?
Prolapse of both the bladder and the urethra
What is the most common cause of rectocele?
Constipation
What is a possible complication of rectocele?
Faecal loading
What is faecal loading?
Loading of faeces into the prolapsed area of rectum, resulting in constipation, urinary retention (urethral compression) and palpable lump in the vagina
Fingers can be used to press backwards to open the bowels
What are some risk factors for pelvic organ prolapse?
- Multiple vaginal deliveries
- Instrumental, prolonged or traumatic delivery
- Advanced age and postmenopause status
- Obesity
- Chronic respiratory disease causing coughing
- Chronic constipation causing straining
What are some presentations of pelvic organ prolapse
- A feeling of “something coming down” in the vagina
- A dragging or heavy sensation in the pelvis
- Urinary symptoms, such as incontinence, urgency, frequency, weak stream and retention
- Bowel symptoms, such as constipation, incontinence and urgency
- Sexual dysfunction, such as pain, altered sensation and reduced enjoyment
- Manual pushing up of the prolapse
How is pelvic organ prolapse examined?
- Empty bladder first
- Sim’s speculum (One bladed)
- Ask woman to cough or bear down
What grading system is used for pelvic organ prolapse?
POP-Q grades 0-5
Grade 0 prolapse
Normal
Grade 1 prolapse
Lowest part 1cm above introitus
Grade 2 prolapse
Lowest part within 1cm of introitus (Above or below)
Grade 3 prolapse
Lowest part >1cm below introitus (Not fully descended)
Grade 4 prolapse
Full descent with eversion of the vagina
What name can be given to prolapse extending beyond the introitus?
Uterine procidentia
What are the 3 types of prolapse management?
Conservative
Vaginal pessary
Surgery
When is conservative management used in pelvic organ prolapse?
women that are able to cope with mild symptoms, do not tolerate pessaries or are not suitable for surgery
What are some conservative management options for pelvic organ prolapse
Physio (Pelvic floor exercises)
Weight loss
Lifestyle changes (For stress incontinence, e.g. caffeine reduction)
Treat related symptoms (E.g. anticholinergics for stress incontinence)
Vaginal oestrogen cream
What are some forms of vaginal pessaries for pelvic organ prolapse
Ring
Shelf and Gellhorn
Cube
Donut
Hodge
Describe the use of vaginal pessaries in pelvic organ prolapse
Women will often have to try a number of different pessaries before they find the most comfortable
They should be washed every 4 months
Oestrogen cream can help to reduce irritation
What is the definitive treatment of pelvic organ prolapse?
Surgery (E.g. hysterectomy)
What is mesh repair in pelvic organ prolapse?
Insertion of mesh to support the pelvic organs
This is controversial and should no longer be used
