Pelvic Organ Prolapse

Question 1

What is pelvic organ prolapse?

Answer 1

A weakening in the supporting tissues or muscles of the pelvic floor

Question 2

The prolapse is often described by the organ that is prolapsed……

Is this a problem with the organ itself?

Answer 2

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

Question 3

How many women in the United States over the age of 45 y.o. suffer from pelvic organ prolapse?

Answer 3

30 Million

Question 4

What percent of women suffering from pelvic organ prolapse actually seek treatment?

Answer 4

15%

Question 5

What are a few of the common causes of pelvic organ prolapse?

Answer 5

Menopause
Childbirth
Pregnancy
Surgery
Obesity
Age

Question 6

T/F: Chronic heavy lifting does not put a patient at risk for pelvic organ prolapse

Answer 6

False

It does increase the risk for pelvic organ prolapse

Question 7

What are some of the symptoms of pelvic organ prolapse?

Answer 7

Bulge in the vagina
Pulling/Stretching sensation in the groin
Dyspareunia
Urinary/Fecal Incontinence
Difficulty with BMs
Delayed/Slowed Urination

Question 8

What is a cystocele?

Answer 8

Bladder prolapses into the vagina

Question 9

A ______ is described as the small bowel prolapsing into the vagina

Answer 9

Enterocele

Question 10

What is a rectocele?

Answer 10

Rectum prolapses into the vaginal

Question 11

What is uterine prolapse?

Answer 11

Uterus prolapses into the vagina

Question 12

What is a vaginal vault prolapse?

Answer 12

The upper portion of the vaginal descends into the vaginal canal

Question 13

What is the most common complaint in a patient with a rectocele?

Answer 13

Difficultly with bowel movements

These patients may even need to insert a finger into the vagina to ‘push’ the rectum back out

Question 14

Are combinations of the various prolapses uncommon?

Answer 14

No

Question 15

What two examinations need to be completed when working up a pelvic organ prolapse?

Answer 15

Speculum Exam

Bimannual Exam

Question 16

T/F: You should always grade a prolapse when documenting including details about location, landmarks, etc….

Answer 16

True

Question 17

Grade ______ (increases/decreases) with the severity of a prolapse

Answer 17

Increases

Question 18

How does a pelvic organ prolapse break down on a 0-4 scale?

Answer 18

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

Question 19

What is the name of the complex, and not widely ued, scoring system for pelvic organ prolapse severity and treatment determination?

Answer 19

POP-Q

Question 20

What are THREE conservative management options for treating pelvic organ prolapse WITHOUT incontinence?

Answer 20

Kegel Exercises
Vaginal Cone Weights
Pessaries

Question 21

When are kegel exercises most beneficial in patients with pelvic organ prolapse?

Answer 21

Early in the ‘disease’ process….once the muscles are too stretched (Grade 3-4) these aren’t as beneficial

Question 22

What are some examples that would indicate treatment for pelvic organ prolapse?

Answer 22

Symptoms become bothersome
Tissues trauma, infection
Urinary Incontinence/Retention

Question 23

Should you discriminate pelvic organ prolapse based on the age of the patient?

Answer 23

NO!

Question 24

T/F: Vaginal Progesterone is used in combination with pessary devices

Answer 24

False

Vaginal Estrogen Therapy is often used in combination

Question 25

What are some side effects associated with pessaries?

Answer 25

Irritation
Erosion
Discharge
Odor

Question 26

T/F: Pessaries need to be regularly maintained by the patient and the physician

Answer 26

True

Question 27

What is the goal of surgery in treating pelvic organ prolapse?

Answer 27

Relieve the patient of their symptoms by repairing each aspect of abnormal pelvic support in a durable and long-lasting manner

Question 28

What are examples of surgeries used in pelvic organ prolapse?

Answer 28

Vaginal Hysterectomy (Uterine Prolapse) 
Anterior Colporrhaphy
Posterior Colporrhaphy
Enterocele Repair
Culdoplasty
Perineoplasty
Sacrospinous Colpopexy