Pelvic Organ Prolapse Flashcards
What is pelvic organ prolapse?
A weakening in the supporting tissues or muscles of the pelvic floor
The prolapse is often described by the organ that is prolapsed……
Is this a problem with the organ itself?
No
Example: The bladder prolapsing into the vagina is described as a cystocele however it is a problem with the vagina rather than the bladder itself
How many women in the United States over the age of 45 y.o. suffer from pelvic organ prolapse?
30 Million
What percent of women suffering from pelvic organ prolapse actually seek treatment?
15%
What are a few of the common causes of pelvic organ prolapse?
Menopause Childbirth Pregnancy Surgery Obesity Age
T/F: Chronic heavy lifting does not put a patient at risk for pelvic organ prolapse
False
It does increase the risk for pelvic organ prolapse
What are some of the symptoms of pelvic organ prolapse?
Bulge in the vagina Pulling/Stretching sensation in the groin Dyspareunia Urinary/Fecal Incontinence Difficulty with BMs Delayed/Slowed Urination
What is a cystocele?
Bladder prolapses into the vagina
A ______ is described as the small bowel prolapsing into the vagina
Enterocele
What is a rectocele?
Rectum prolapses into the vaginal
What is uterine prolapse?
Uterus prolapses into the vagina
What is a vaginal vault prolapse?
The upper portion of the vaginal descends into the vaginal canal
What is the most common complaint in a patient with a rectocele?
Difficultly with bowel movements
These patients may even need to insert a finger into the vagina to ‘push’ the rectum back out
Are combinations of the various prolapses uncommon?
No
What two examinations need to be completed when working up a pelvic organ prolapse?
Speculum Exam
Bimannual Exam
T/F: You should always grade a prolapse when documenting including details about location, landmarks, etc….
True
Grade ______ (increases/decreases) with the severity of a prolapse
Increases
How does a pelvic organ prolapse break down on a 0-4 scale?
0 - none 1 - mild defect, not visible without speculum (descent halfway to hymen) 2 - prolapse to hymen 3 - prolapse beyond hymen (halfway past) 4- complete prolapse
What is the name of the complex, and not widely ued, scoring system for pelvic organ prolapse severity and treatment determination?
POP-Q
What are THREE conservative management options for treating pelvic organ prolapse WITHOUT incontinence?
Kegel Exercises
Vaginal Cone Weights
Pessaries
When are kegel exercises most beneficial in patients with pelvic organ prolapse?
Early in the ‘disease’ process….once the muscles are too stretched (Grade 3-4) these aren’t as beneficial
What are some examples that would indicate treatment for pelvic organ prolapse?
Symptoms become bothersome
Tissues trauma, infection
Urinary Incontinence/Retention
Should you discriminate pelvic organ prolapse based on the age of the patient?
NO!
T/F: Vaginal Progesterone is used in combination with pessary devices
False
Vaginal Estrogen Therapy is often used in combination
What are some side effects associated with pessaries?
Irritation
Erosion
Discharge
Odor
T/F: Pessaries need to be regularly maintained by the patient and the physician
True
What is the goal of surgery in treating pelvic organ prolapse?
Relieve the patient of their symptoms by repairing each aspect of abnormal pelvic support in a durable and long-lasting manner
What are examples of surgeries used in pelvic organ prolapse?
Vaginal Hysterectomy (Uterine Prolapse) Anterior Colporrhaphy Posterior Colporrhaphy Enterocele Repair Culdoplasty Perineoplasty Sacrospinous Colpopexy
