Pelvic Organ Prolapse Flashcards
Female pelvic organ prolapse
Refers to the descent of the pelvic organs towards or through the vagina.
What are the three layers of the pelvic floor?
- Endo-pelvic fascia
- Pelvic Diaphragm
- Urogenital Diaphragm
Risk factors for pelvic organ prolapse
- pregnancy and vaginal birth
- advancing age
- obesity
- continence procedure
- hysterectomy
- constipation
- Weight lifting, high-impact aerobics and long-distance running
Factors during birth that increase risk of pelvic organ prolapse
- Forceps Delivery
- Large baby (> 4500 gm)
- Prolonged Second Stage
Traditional classification of prolapse
- Urethrocele: Prolapse of the lower anterior vaginal wall involving the urethra only.
- Cystocele: Prolapse of the upper anterior vaginal wall involving the bladder.
- Uterovaginal prolapse. This term is used to describe prolapse of the uterus, cervix and upper vagina.
- Enterocele: Prolapse of the upper posterior wall of the vagina usually containing loops of small bowel
- Rectocele: Prolapse of the lower posterior wall of the vagina involving the rectum bulging forwards into the vagina.
Typical symptoms in women with pelvic organ prolapse - Vaginal
- Sensation of a bulge or protrusion
- Seeing or feeling a bulge or protrusion
- Pressure
- Heaviness
- Difficulty in inserting tampons
Typical symptoms in women with pelvic organ prolapse – Urinary
- Urinary Incontinence
- Frequency/ Urgency
- Weak or prolonged urinary stream/ Feeling of incomplete emptying
- Manual reduction of prolapse to start or complete voiding
Typical symptoms in women with pelvic organ prolapse – Bowel
- Incontinence of flatus, or liquid or solid stool
- Feeling of incomplete emptying/ Straining
- Urgency
- Digital evacuation to complete defecation
- Pushing on or around the vagina or perineum, to start or complete defecation
Assessment of pelvic organ prolapse
- Examination to exclude pelvic mass
- Record the position of examination: left lateral Vs Lithotomy Vs Standing.
- Quality of Life
- POPQ score
Pelvic organ prolapse investigations
- Urodynamics: concurrent UI or to exclude Occult SI
- IVU or Renal USS (if suspicion of ureteric obstruction)
Pelvic organ prolapse prevention
- Avoid constipation.
- Effective management chronic chest pathology (COPD & asthma).
- Antenatal and post-natal pelvic floor muscle training
Incidence of pelvic organ prolapse
Affects 50% of multiparous women with 10% symptomatic
Treatment types for pelvic organ prolapse.
- physiotherapy
- vaginal pessaries
- surgery
Pelvic floor muscle training
- Increase the pelvic floor strength & bulk and relieves the tension on the ligaments in cases of mild prolapse.
- Appropriate for younger women who have not yet completed their family.
- No role in advanced cases.
- Cannot treat fascial defects.
Advantages of silicone pesseries
- Long Shelf-life
- Resistance to autoclaving and repeated cleaning
- Non-absorbent towards secretions and odors
- Inertness
- Hypoallergenic nature
