Pelvic organ prolapse Flashcards
Definition
When abdominal organs come through the vagina as there is failure of support of pelvic organs
Anterior prolapse
Bladder drops into vagina
Middle or apical prolapse
Uterus/vault drops into vagina
Posterior prolapse
Rectum drops into vagina
Causes
Age
Parity
Previous vaginal deliveries
Obesity
Clinical features
Pressure Storage symptoms - frequency - urgency Incontinence Voiding symptoms Post micturation symptoms - incomplete emptying Sexual dysfunction
Investigations
US
MRI
Anorectal manometry
Quantification system
POP-Q
Management for mild-moderate prolapse
Pelvic floor exercises
Vaginal pessary
Management for severe prolapse
Surgery
- pelvic floor repair
- sacrospinous fixation
What are you potentially at risk of injuring during sacrospinous fixation?
Injury to pudendal nerve and sciatic nerve
What is the most common type of prolapse?
Anterior prolapse
What is an anterior prolapse called?
Cystocele
Cystocele - clinical features
Bladder symptoms Bulge Pressure "mass" Incomplete bladder emptying Difficulty inserting tampon Dyspareunia Urge incontinence
Cystocele - management
Pessary
Surgery
What is a middle prolapse called?
Uterine prolapse
Uterine prolapse - clinical features
Dragging, heavy sensation Back pain Mass Difficulty inserting/retaining tampon Dyspareunia
Uterine prolapse - management
Pessary
What is a posterior prolapse called?
Rectocele
Rectocele - clinical features
Bulging Pressure Difficulty defecating Incomplete defecation Digitation
Rectocele - management
Pessary
Vaginal vault prolapse happens when
Following hysterectomy
Name 3 complications of long term pessary
Vaginal discharge
Ulceration
Formation of fibrous bands (attaching pessary to vagina)
How often should pessaries be changed?
Every 6 months
