Pelvic Organ Prolapse

Question 1

Describe the pathophysiology of pelvic organ prolapse

Answer 1

• Loss of pelvic support (ligaments, fascia, pelvic floor)
• Generally arises from laxity caused by pelvic floor pathology

Question 2

Describe some risk factors for pelvic organ prolapse

Answer 2

• Parity/vaginal delivery, age, menopause, hysterectomy, congenital defects such as collagen defects, spina bifida, bladder extrophy. High impact activities, heavy lifting, chronic cough and constipation

Question 3

What is the classification system used to describe levels of pelvic organ prolapse?

Answer 3

• POPQ

Question 4

What might be some of the presenting symptoms in someone with pelvic organ prolapse?

Answer 4

• Asymptomatic
• Protruding bulge from vaginal opening
• Pelvic pressure/backache after prolonged standing
• Ulceration/bleeding from prolapsed vaginal skin
• Difficulty with urination/defecation
• Incontinence

Question 5

Describe the management of pelvic organ prolapse

Answer 5

• Conservative
  
  • No treatment
  • Pelvic floor exercises
  • Oestrogen replacement
  • Lifestyle changes - weight loss, avoiding heavy duties, heavy lifting, constipation.
  • Pessary - supportive vaginal devices. Effective in symptomatic relief
• Surgical
  
  • Anterior/posterior colporrhapy - anterior/posterior repair
  • Enterocoele repair = McCall caldeplasty
  • Vaginal hysterectomy/hysteropexy - for uterine prolapse
  • Sacrospinous fixation or abdominal sacral colpopexy - for vault prolapse
  • Suturing mesh graft to sacrum and anterior/posterior walls of vagina