Pelvic organ prolapse Flashcards
What are the 3 ;ayers of the pelvic floor?
Endo-pelvic fascia
Pelvic diaphragm
Urogenital diaphragm
What is the endo-pelvic fascia?
Network of fibre-muscular connective type tissue that has a hammock like configuration and surrounsthe important visceral structures
What are the components of the endo-pelvic fascia?
Uterosacral ligaments
Pubocervocal ligaments
Rectovaginal fascia
What is the function of the uyerosacral ligaments?
Allow limited side to side movement of the ecrvix
Where do the uterosacral ligaments tend to break?
Medially around cervix
What is the function of the pubocervical fascia?
Provide main support of anterior vaginal wall
Where does the pubocervical fascia tend to break?
Lateral attachments or immediately in front of cervix
Where does the rectovaginal fascia tend to break>
Centrally
What does an upper defect of the rectovaginal fascia cause?
Enterocoele
What does a lower defect of the rectovaginal fascia cause?
Perineal boy descent and rectocele
What is the pelvic diaphragm comprised of?
Levator ani and coccygeus muscles
What is the urogenital diaphragm comprised of?
Superficial and deep transverse perineal muscles and their fascia
What is female pelvic organ prolapse?
Descent of pelvic organs towards or through vagina
What are the risk factors?
Pregnancy Vaginal birth- forceps, big baby or prolonged second stage Advancing age Obesity Previous pelvic surgery Hormonal factors Quality of connective tissue COnstipation Heavy lifting High impact exercise
What is a urethrocoele?
Prolapse of lower anterior vaginal wall involving urethra only
Wha is a cystocoele?
Prolapse of upper anterior vaginal wall involving the bladder
What is a uterovaginal prolapse?
Prolapse of uterus, cervix and upper vagina
What is an enterocoele?
Prolapse of upper posterior wall of vagina, usually containing loops of small bowel
What is a rectocoele?
Prolapse of lower posterior wall of vagina involving rectum bulging forwards into the vagina
What are the vaginal signs and symptoms of a prolapse?
Sensation of bulge or protrusion
Pressure
Heaviness
Difficulty inserting tampons
What are the symptoms of a urinary prolapse?
Urinary incontinence Frequency/urgency Weak/prolonged stream Hesitancy Incomplete emptying Manual reduction of prolapse to start/finish
What are the symptoms of a bowel prolapse?
Incontinence Feeling of incomplete emptying Straining Urgency Digital evacuation to finish Splinting of prolapse to start/finish
What is done to assess?
Examination
Asses quality of life
Objective- POPQ score
What is done to prevent?
Avoid constipation
Effective management of chronic chest pathology
Smaller family
Improvements in antenatal and intrapartum care
Pelvic floor exercises
What is the treatment?
Physio- if mild
Pessaries
Surgery
