Pelvic Organ Prolapse Flashcards
___ is a weakening of the supporting tissues or muscles of the pelvic floor
Pelvic organ prolapse
__% women > 45 y/o suffer from some type of prolapse.
But only __% of women affected by prolapse seek tx.
50%
15%
What are some common causes of prolapse?
Menopause Pregnancy and Childbirth Prior Surgery Obesity Aging Chronic Heavy Lifting
What are some common sx of prolapse?
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
___ is when the bladder falls into the vagina
Cystocele
___ is when the small bowel falls into the vagina
Enterocele
___ is when the rectum falls into the vagina
What is the most common sx?
Rectocele
Constipation/difficulty having a BM
___ is when the uterus falls into the vagina
Uterine prolapse
___ occurs when the upper portion of the vagina descends into the vaginal canal
vaginal vault prolapse
What is included in the exam of prolapse?
Speculum exam
Bimanual exam
Dorsal lithotomy and standing
How can you have a prolapse w/o incontinence?
Urethra may be “kinked”
A ____ exam helps define the location and degree of prolapse
speculum
What systems are used to describe prolapse?
Grading systems
POP Q (quantification system)
Class system
Grading system
Range: ___-___
What does grading increase w/?
What anatomical reference points are used in the grading system?
Range: 0-3/4
Increases w/ severity or prolapse in reference to vaginal landmarks
hymen or introitus
___ refers to complete prolapse
Procidentia
Using the grading system... 0 = \_\_\_ 1 = \_\_\_ 2 = \_\_\_ 3 = \_\_\_ 4 = \_\_\_
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
POP Q measures __(#)__ points in relation to the ___
6, hymen
The 6 points of the POQ gives what 3 measurements?
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)
Using the POP Q 0 = \_\_\_\_ 1 = \_\_\_\_ 2 = \_\_\_\_ 3 = \_\_\_\_ 4 = \_\_\_\_
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)
What are conservative therapies for prolapse?
Strengthening the pelvic floor
- Kegel Exercises
- Vaginal Cone Weights
Supporting the pelvic floor
- Pessaries (weird ring things)
What are surgical solutions for prolapse?
Surgical Solutions
- Surgical Repair
- Mesh Repair
When should prolapse be tx?
Sx reach a bother scale to pt
Tissue trauma or other ill effects
Associated urinary incontinence
What are some side effects of using a pessary?
irritation
erosion
discharge
odor
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
Sx
pelvic support
