Pelvic organ prolapse Flashcards
what is pelvic organ prolapse
downward displacement of one or all pelvic organs from its normal location resulting in Vaginal protrusion or bulge
POP involves herniating what organs?
Bladder Urethra Rectum Uterus Small bowel
why POP is common in menopause
bcoz lack of hormonal support
why POP is related to parity
the more the woman has delivered (esp NSVD) more chance for her to prolapse
components of Levator ani muscles
pubococcygeus
puborectalis
iliococcygeus
innervations of levator ani muscles
pudendal nerve
perineal nerve
inferior rectal nerve
this is utilized as an anchor pt for prolapsed organ in the mgt
sacrospinous ligament
Level I support system for the uterus and vagina
utersacral/cardinal ligament complex, w/c serve to maintain the vaginal lengh and axis
Level II support system for the uterus and vagina
consists of paravaginal attachments of the lateral vagina and endopelvic fascia to the arcus tendineus that maintain the midline position of the vagina
Level III support system for the uterus and vagina
made up muscles and con tis surrounding the distal vagina and perineum
muscle that is most stretched during the 2nd stage of labor that causes direct injury
pubococcygeus
neurologic injury involves injury to the
pudendal nerve
vaginal delivery, chronic straining and w/ defacation in constipation can lead to what kind of injury
neurologic injury (stretching injury to pudendal nerve)
if you want to locate the pudendal nerve this is a good landmark
ischial spine
in identifying the pudendal nerve, after you have located the ischial spine what should you look for next
sacrospinous ligament. there, behind the sacrospinous ligament is the pudendal nerve.
sacropspinous ligament is attached to the ischial spine
mechanisms involved in vaginal wall injury
site specific defects
smooth muscle dysfunction
con tis abnormalities
w/c is worse among the site specific defects
displacement type
in this defect the structure is distorted but the organs are still attached to the pelvic side wall
distention type
in this defect there is loss of con tis attachment of lateral vaginal wall to pelvic side wall
displacement type
this is responsible for the anteflexed position so there is loss of the normally anteflexed or anteverted position of the uterus
round ligament
in this defect there is abnormality in the attachment of lateral vagina to pelvic side wall
smooth muscle dysfxn
vaginal wall injury that causes POP among menopausal women and those with Ehler Danlos and Marfan syndrome
Con tis Abnormalities (less collagen content & con tis d/o)
Risk factors for POP
multiparity Age Race Increased ab pressure Con tis dse
why are caucasians more prone to POP while blacks are less prone
Caucasians usually have gynecoid pelvis which has a wider pubic arch;
blacks have narrow
conditions that would lead to increased abdominal pressure that puts px at risk for POP
obesity chronic constipation chronic coughing repetitive heavy lifting inhaled chem in tobacco
types of anterior wall prolapse
cystocele
cystourethrocele
urethrocele
types of posterior wall prolapse
rectocele
enterocele
types of middle wall/apical compartment prolapse
uterine prolapse
vaginal vault prolapse
occurs when the bladder drops from its normal place into the vagina
cystocele
cystocele is most common in
elderly
cystocele is caused by
rupture of the pubovesical fascia
how does cystocele cause problems in urination
it may cause a kink in the urethra
most common prolapse in women
cystourethrocele
what happens in cystourethrocele
both bladder and the urethra prolapse together in the vaginal wall
prolapse of urethra outward to vaginal wall
urethrocele
in urethrocele w/c is prolapsing: urethral canal or meatus
canal the meatus is still present below
Px came in with cc of a heavy feeling in the vagina as if something is falling out, she also feels constipated. PE showed bulging rectum towards the vagina. What is the mechanism in this disorder?
this is a rectocele, it occurs when the rectum loses it support and bulges into the back wall of the vagina
prolapse of the portion of the small bowel behind the uterus toward the pouch of douglas due to weakened support
enterocele
enterocele often occurs at the same time with
rectocele or uterine prolapse
differentiate enterocele from rectocele
Entero is a separate bulge above the rectocele
rectocele is lower than enterocele
True hernia of the peritoneal cavity
enterocele
true hernia of the pelvic cavity
cysocele and rectocele
cause of uterine prolapse
poor cardinal or uterosacral ligament apical support; relaxation of the pelvic floor muscles esp levator ani
degree of uterine prolapse wherein the cervix sticks to the vaginal introitus/thru the vaginal barrel to the region of the introitus
2nd degree
degree of uterine prolapse where the cervix droops into the vagina/ upper barrel of the vagina
1st degree
degree of uterine prolapse where the cervix and uterus prolapse out thru the introitus
3rd degree
px undergo vaginal hysterectomy what could be a common complication
vaginal vault prolapse
mgt objective in POP
restore normal anatomy
what is a vaginal pessary
plastic device placed in the vagina to help support the bladder, vagina, uterus or rectum
standard nonsurg treatment for POP
Vaginal pessary
PFMT/kegel exercises strengthen which muscles
pubococcygeous muscles
types of conservative mgt for POP
Vaginal pessary
PFMT
px education and lifestyle modification
Surginacl procedure for anterior or posterior wall prolapse
vaginal colporrhapy
rectopubic and paravaginal defect repair
transvaginal permanent mesh replacement
surg procedure for uterine preservation
modified manchester
uterosacral vaginal hysteropexy
surg procedure for post hysterectomy vaginal vault prolapse
sacrocolpoplexy
sacrospinous fixatoin
uterosacral plication
colpcleisis