Pelvic Organ Prolapse

Question 1

___ is a weakening of the supporting tissues or muscles of the pelvic floor

Answer 1

Pelvic organ prolapse

Question 2

__% women > 45 y/o suffer from some type of prolapse.

But only __% of women affected by prolapse seek tx.

Answer 2

50%

15%

Question 3

What are some common causes of prolapse?

Answer 3

Menopause
Pregnancy and Childbirth
Prior Surgery
Obesity
Aging
Chronic Heavy Lifting

Question 4

What are some common sx of prolapse?

Answer 4

Bulge or lump in the vagina
A pulling or stretching feeling in the groin area
Difficult or painful sexual intercourse
Urinary or fecal incontinence
Difficulty w/ BMs
Delayed or slow urinary stream

Question 5

___ is when the bladder falls into the vagina

Answer 5

Cystocele

Question 6

___ is when the small bowel falls into the vagina

Answer 6

Enterocele

Question 7

___ is when the rectum falls into the vagina

What is the most common sx?

Answer 7

Rectocele

Constipation/difficulty having a BM

Question 8

___ is when the uterus falls into the vagina

Answer 8

Uterine prolapse

Question 9

___ occurs when the upper portion of the vagina descends into the vaginal canal

Answer 9

vaginal vault prolapse

Question 10

What is included in the exam of prolapse?

Answer 10

Speculum exam
Bimanual exam
Dorsal lithotomy and standing

Question 11

How can you have a prolapse w/o incontinence?

Answer 11

Urethra may be “kinked”

Question 12

A ____ exam helps define the location and degree of prolapse

Answer 12

speculum

Question 13

What systems are used to describe prolapse?

Answer 13

Grading systems
POP Q (quantification system)
Class system

Question 14

Grading system
Range: ___-___
What does grading increase w/?

What anatomical reference points are used in the grading system?

Answer 14

Range: 0-3/4

Increases w/ severity or prolapse in reference to vaginal landmarks

hymen or introitus

Question 15

___ refers to complete prolapse

Answer 15

Procidentia

Question 16

Using the grading system...
0 = \_\_\_
1 = \_\_\_
2 = \_\_\_
3 = \_\_\_
4 = \_\_\_

Answer 16

0 - none
1 - mild defect, not visible w/o speculum (descent halfway to hymen)
2 - prolapse to hymen
3 - prolapse beyond hymen (halfway past)
4 - complete prolapse

Question 17

POP Q measures __(#)__ points in relation to the ___

Answer 17

6, hymen

Question 18

The 6 points of the POQ gives what 3 measurements?

Answer 18

GH = Genital Hiatus (btwn urethra and bottom of vagina)
PB = Perineal Body (btwn vagina and anus)
TVL= Total Vaginal Length (distance from external vagina to cervix)

Question 19

Using the POP Q
0 = \_\_\_\_
1 = \_\_\_\_
2 = \_\_\_\_
3 = \_\_\_\_
4 = \_\_\_\_

Answer 19

0 = no prolapse, anterior and posterior points are all -3cm

1 = stage 0 criteria not met, most distal prolapse is > 1 cm above the level of the hymen (-1)

2 = Most distal prolapse if between 1 cm above and 1 cm below he hymen

3 = the most distal prolapse is more than 1 cm below the hymen but no further than 2 cm less then TVL

4 = represents complete procidentia or vault eversion; the most distal prolapse protrudes to at least (-2cm)

Question 20

What are conservative therapies for prolapse?

Answer 20

Strengthening the pelvic floor

• Kegel Exercises
• Vaginal Cone Weights

Supporting the pelvic floor
- Pessaries (weird ring things)

Question 21

What are surgical solutions for prolapse?

Answer 21

Surgical Solutions

• Surgical Repair
• Mesh Repair

Question 22

When should prolapse be tx?

Answer 22

Sx reach a bother scale to pt

Tissue trauma or other ill effects

Associated urinary incontinence

Question 23

What are some side effects of using a pessary?

Answer 23

irritation
erosion
discharge
odor

Question 24

Goal of surgery for prolapse is to relieve the pt of her ____ by repairing each aspect of abnormal ___ ___ in a durable and long-lasting manner

Answer 24

Sx

pelvic support