Pelvic Organ Prolapse Flashcards
What is a prolapse in terms of female physiology?
Descent of the pelvic organs towards or through the vagina
What are the 3 layers of the pelvic floor?
Endo-pelvic fascia
Pelvic diaphragm
Urogenital diaphragm
What are the features of the endocrine-pelvic fascia?
Fibro muscular component can stretch
Connective tissue doesn’t stretch so breaks
How is the utero-sacral complex palpated?
Down traction on cervix
If intact will allow limited side to side movement of cervix
How does the utero sacral complex tend to break?
Medially around the cervix
What is the main function of the pubocervical fascia?
Main support of the anterior vaginal wall
How does the pubocervical fascia tend to break?
Breaks at lateral attachments or immediately in front of the cervix
Where does the rectovaginal fascia tend to break?
Upper defect breaks at enterocele
Lower defect breaks at perineal body descent and rectocele
What are the risk factors for pelvic organ prolapse?
Pregnancy and vaginal delivery Forceps delivery Large baby Prolonged second stage of labour Advancing age Obesity Previous pelvic surgery Occupation with heavy lifting
Define urethocele
Prolapse of the lower anterior vaginal wall involving the urethra only
Define cystocele
Prolapse of the upper anterior vaginal wall involving the bladder
Define uterovaginal prolapse
Prolapse of the uterus, cervix and upper vagina
Define enterocele
Prolapse of the upper posterior wall of the vagina usually containing small loops of bowel
Define rectocele
Prolapse of the lower posterior wall of the vagina involving the rectum bulging forwards into the vagina
What are the vaginal symptoms of pelvic organ prolapse?
Sensation of a bulge or protrusion Seeing or feeling a bulge or protrusion Pressure Heaviness Difficulty inserting tampons
