Pelvic Organ Prolapse Flashcards
What is female POP?
Descent of pelvic organs towards/through the vagina
How common is POP?
12-30% of multiparous women
2% of nulliparous women
What is the role of the pelvic floor?
Regulate intra-abdominal pressure
Support pelvic viscera
What are the layers of the pelvic floor?
Endo-pelvic fascia
Pelvic diaphragm
Urogenital diaphragm
What makes up the endopelvic fascia?
Fibro-muscular tissue which surrounds the visceral structure
What makes up the pelvic diaphragm?
Layer of striated muscle
What makes up the urogenital diaphragm?
Superficial + deep transverse perineal muscles with their fascia
How does the utero-sacral ligament break?
Medially around the cervix
Causes the cervix to drop
What is the role of the pubocervical fascia?
Provide main support to anterior vaginal wall
How does the pubocervical fascia tend to break?
Lateral attachments
Immediately in front of cervix
How does the rectovaginal fascia tend to break?
Centrally
Upper: Enterocele
Lower: Perineal body descent & rectocele
What are the risk factors for POP?
Multiparity Old age Obesity Forcep delivery Big baby Prolonged second stage Previous pelvic surgery Constipation Exercise
What surgeries are risk factors for POP?
Continence procedures
Burch colposuspension
Hysterectomy
What are the main types of prolapse?
Urethrocele Cystocele Uterovaginal prolapse Enterocele Rectocele
What is urethrocele?
Lower anterior vaginal wall containing urethra only
What is cystocele?
Upper anterior vaginal wall involving bladder
What is enterocele?
Upper posterior vaginal wall and small bowel
What is rectocele?
Lower posterior vaginal wall and rectum
What are the typical POP symptoms?
Sensation of bulge/protrusion Pressure Heaviness Difficulty inserting tampons Incontinence/frequency Weak stream Incontinence bowel/urgency Straining Digital evacuation to complete Splinting
What is splinting?
Pressing on the perineum to complete a bowel movement
How is POP assessed?
Most excluse pelvic mass
Baden-Walker-Halfawy Grading
POPQ Score (gold standard)
Which investigations are used for POP?
USS/MRI - fascial weakness
Urodynamics
IVU/renal USS
How is POP prevented?
Avoid constipation
Manage chest pathology
Smaller family size
How is POP treated?
Physiotherapy (Pelvic floor muscle training)
Pessaries
Surgery
