Pelvic Organ Prolapse

Question 1

What are the symptoms of pelvic organ prolapse?

Answer 1

Pelvic pressure, dyspareunia, bowel difficulties, palpable bulge in the vagina, urinary difficulty

Common caused by pregnancy, or chronic elevation in abdominal pressure (obesity, cough, lifting, connective tissue disorders, atrophic change)

Question 2

Which patients are pelvic organ prolapse seen in

Answer 2

Post-menopausal = lack of estrogen results in atrophy = decreased elasticity

Question 3

What can paradoxically improve with pelvic organ prolapse

Answer 3

Stress incontinence because prolapse can cause kink in urethra and prevent leakage

Question 4

What is splinting?

Answer 4

Use of manual pressure to perineum or posterior vaginal wall to help with defecation

Question 5

How is the physical exam performed to assess POP?

Answer 5

split-speculum exam

Question 6

What is the complete eversion of the vagina by the uterus called?

Answer 6

Complete procidentia

Question 7

How is POP assessed?

Answer 7

Pelvic organ prolapse quantitative scale based on fixed point of reference: the hymen

Question 8

Treatment of POP?

Answer 8

Expectant management
Kegel exercises to strength floor
Pessaries (support devices)
Surgical repair (possibly hysterectomy)
In post-menopausal, low-dose vaginal estrogen

Question 9

How is surgical repair for POP done?

Answer 9

Anterior and posterior colporrhaphy

Repair of fascial defect

Question 10

What is done after hysterectomy for uterine prolapse?

Answer 10

Apical suspension for prevention of vaginal vault prolapse

Question 11

What is last ditch option for POP repair?

Answer 11

Colpocleisis = obliteration of vaginal canal to prevent prolapse = no longer plan intercourse and are poor surgical candidates