Pelvic organ prolapse

Question 1

What are the 3 ;ayers of the pelvic floor?

Answer 1

Endo-pelvic fascia
Pelvic diaphragm
Urogenital diaphragm

Question 2

What is the endo-pelvic fascia?

Answer 2

Network of fibre-muscular connective type tissue that has a hammock like configuration and surrounsthe important visceral structures

Question 3

What are the components of the endo-pelvic fascia?

Answer 3

Uterosacral ligaments
Pubocervocal ligaments
Rectovaginal fascia

Question 4

What is the function of the uyerosacral ligaments?

Answer 4

Allow limited side to side movement of the ecrvix

Question 5

Where do the uterosacral ligaments tend to break?

Answer 5

Medially around cervix

Question 6

What is the function of the pubocervical fascia?

Answer 6

Provide main support of anterior vaginal wall

Question 7

Where does the pubocervical fascia tend to break?

Answer 7

Lateral attachments or immediately in front of cervix

Question 8

Where does the rectovaginal fascia tend to break>

Answer 8

Centrally

Question 9

What does an upper defect of the rectovaginal fascia cause?

Answer 9

Enterocoele

Question 10

What does a lower defect of the rectovaginal fascia cause?

Answer 10

Perineal boy descent and rectocele

Question 11

What is the pelvic diaphragm comprised of?

Answer 11

Levator ani and coccygeus muscles

Question 12

What is the urogenital diaphragm comprised of?

Answer 12

Superficial and deep transverse perineal muscles and their fascia

Question 13

What is female pelvic organ prolapse?

Answer 13

Descent of pelvic organs towards or through vagina

Question 14

What are the risk factors?

Answer 14

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

Question 15

What is a urethrocoele?

Answer 15

Prolapse of lower anterior vaginal wall involving urethra only

Question 16

Wha is a cystocoele?

Answer 16

Prolapse of upper anterior vaginal wall involving the bladder

Question 17

What is a uterovaginal prolapse?

Answer 17

Prolapse of uterus, cervix and upper vagina

Question 18

What is an enterocoele?

Answer 18

Prolapse of upper posterior wall of vagina, usually containing loops of small bowel

Question 19

What is a rectocoele?

Answer 19

Prolapse of lower posterior wall of vagina involving rectum bulging forwards into the vagina

Question 20

What are the vaginal signs and symptoms of a prolapse?

Answer 20

Sensation of bulge or protrusion
Pressure
Heaviness
Difficulty inserting tampons

Question 21

What are the symptoms of a urinary prolapse?

Answer 21

Urinary incontinence
Frequency/urgency
Weak/prolonged stream
Hesitancy
Incomplete emptying
Manual reduction of prolapse to start/finish

Question 22

What are the symptoms of a bowel prolapse?

Answer 22

Incontinence
Feeling of incomplete emptying
Straining
Urgency
Digital evacuation to finish
Splinting of prolapse to start/finish

Question 23

What is done to assess?

Answer 23

Examination
Asses quality of life
Objective- POPQ score

Question 24

What is done to prevent?

Answer 24

Avoid constipation
Effective management of chronic chest pathology
Smaller family
Improvements in antenatal and intrapartum care
Pelvic floor exercises

Question 25

What is the treatment?

Answer 25

Physio- if mild
Pessaries
Surgery