Pelvic Organ Prolapse

Question 1

what are the three distinct layers of the pelvic floor?

Answer 1

> pelvic diaphragm (striated muscle)
endopelvic fascia (network of fibro-muscular connective tissue)
urogenital diaphragm (superficial and deep transverse perineal muscles with fascial coverings)

Question 2

what fascia make up the pelvic floor?

Answer 2

> uterosacral ligaments
pubocervical fascia
rectovaginal fascia

Question 3

what muscle does the uterosacral fascia cover?

Answer 3

the piriformis

Question 4

what fascia provides main support for the abdominal wall?

Answer 4

pubocervical fascia

Question 5

what are the risk factors for pelvic organ prolapse?

Answer 5

> pregnancy and childbirth
 - forceps delivery
 - large baby
 - prolonged second stage
> advancing age
> obesity
> previous pelvic surgeries (continence procedures)
> quality of the connective tissue
> heavy lifting
> constipation
> exercise

Question 6

what different classifications are there for pelvic wall prolapse?

Answer 6

> posterior wall prolapse
anterior wall prolapse (bladder or urethra)
atypical prolapse (upper wall of vagina)

Question 7

what vaginal symptoms can prolapse cause?

Answer 7

> sensation of bulge (seeing protrusion)
pressure
heaviness
difficulty inserting tampon

Question 8

what urinary symptoms may prolapse cause?

Answer 8

> urgency
> incontinence
> frequency
> hesitancy
> feeling of incomplete voiding
> manual reduction of prolapse to void (splinting)

Question 9

what bowel symptoms may prolapse cause?

Answer 9

> incontinence 
> urgency
> feeling of incomplete emptying
> splinting to defecate
> digital evacuation to complete
> straining

Question 10

what objective grading scores are there in pelvic organ prolapse?

Answer 10

> Braden walker halfway grading

> POPQ score

Question 11

what investigations can you carry out in pelvic organ prolapse?

Answer 11

> USS/MRI (identify fascial defects)
urodynamics
IVU/ renal USS (exclude uretic obstruction)

Question 12

how can pelvic organ prolapse be prevented?

Answer 12

> avoid constipation
manage chronic chest pathology
smaller family size
improve antenatal and intrapartum care (pelvic floor training exercises)

Question 13

what management options are there for pelvic organ prolapse?

Answer 13

> silicone pessaries

> surgery aiming to relieve symptoms, restore bowel and bladder function and maintain vaginal capacity for sex