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Reproductive System > Pelvic Organ Prolapse > Flashcards

Pelvic Organ Prolapse Flashcards

1
Q

What are the parts of the pelvic floor?

A

Three distinct layers:

  • Endopelvic fascia: fibromuscular connective type tissue
  • Pelvic Diaphragm: striated muscle (levator ani + coccygeus)
  • Urogenital Diaphragm: superficial and deep transverse perineal muscles
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2
Q

What structures make up the endopelvic fascia?

A
  • Uterosacral ligament
  • Pubocervical fascia
  • Rectovaginal fascia
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3
Q

Risk factors for POP?

A

Pregnancy and vaginal birth:

  • Forceps delivery
  • Macrosomia = large baby
  • Prolonged 2nd stage of labour
  • Parity

Age

Obesity

Previous pelvic surgery:

  • Hysterectomy
  • Colposuspension

Other

  • Constipation
  • Heavy lifting
  • Exercise
  • Hormonal
  • CT disease
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4
Q

Traditionally how do we classify POP?

A
  • 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: prolapse of the uterus, cervix and upper vagina (apical prolapse)
  • 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.
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5
Q

Describe the symptoms of having a vaginal POP?

A
  • Bulge/protrusion sensation
  • Bulge/protrusion visible/palpable
  • Pressure
  • Heaviness
  • Tampon insertion difficulties
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6
Q

How can you score POP?

A

POPQ score is gold standard- gives a staging from 0-6

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7
Q

How can you investigate POP?

A
  • USS / MRI: Allow identification of fascial defects
  • Urodynamics: concurrent UI or to exclude Occult SI
  • IVU or Renal USS (if suspicion of ureteric Obstruction)
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8
Q

How do we prevent a POP?

A
  • Avoid constipation.
  • Manage chronic chest pathology (COAD & asthma).
  • Smaller family size.
  • Pelvic floor muscle training antenatally and post-partum
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9
Q

How can we treat POP?

A
  • Pelvic Floor muscle Training (PFMT)
  • Pessaries
  • Surgery
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10
Q

What is a urethrocele?

A

Prolapse of the urethra into ANTERIOR VAGINAL WALL

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11
Q

What is a cystocele?

A

Prolapse of the bladder into ANTERIOR VAGINAL WALL

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12
Q

What is a uterovaginal prolapse?

A

Prolapse of uterus, CERVIX and vagina

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13
Q

What is a rectocele?

A

Prolapse of the rectum into the POSTERIOR VAGINAL wall

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14
Q

What is an enterocele?

A

Prolapse of small loops of bowel into the POSTERIOR WALL of vagina

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15
Q

What are the urinary symptoms of a prolapse?

A
  • Urinary Incontinence
  • Frequency/ Urgency
  • Weak or prolonged urinary stream/ Hesitancy/ Feeling of incomplete emptying
  • Manual reduction of prolapse to start or complete voiding
  • Need to lean more forwards/backawards to empty the bladder.
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16
Q

What are the bowel symptoms of a prolapse?

A
  • Incontinence of flatus, or liquid or solid stool
  • Feeling of incomplete emptying/ Straining
  • Urgency
  • Digital evacuation to complete defecation
  • Splinting, or pushing on or around the vagina or perineum, to start or complete defecation
17
Q

How does pelvic floor training work?

A

Increase the pelvic floor strength and bulk which relieve the tension on the ligaments

18
Q

What is the aim of surgery?

A
  • Relieve symptoms
  • Restore/maintain bladder and bowel function
  • Maintain vaginal capacity for sexual function

OFTEN IT IS WISER TO USE PESSARIES

19
Q

What are the levels of endopelvic support?

A

Level I: Utero-sacral ligaments and Cardinal ligaments

Level II: Para-vagina to arcus tendineus fascia: Pubocervical/ Rectovaginal fascia

Level III: Urogenital Diaphragm and perineal body

20
Q

How common is it to be symptomatic in prolapse?

A

Found asymptomatically in 50%

Found Symptomatically in 2%

21
Q

Describe the symptoms of having a urinary POP?

A
  • Urinary Incontinence
  • Frequency/ Urgency
  • Weak or prolonged urinary stream/ Hesitancy/ Feeling of incomplete emptying
  • Problems with voiding - manual reduction of prolapse to start or complete voiding
22
Q

Describe the symptoms of having a bowel POP?

A
  • Incontinence of flatus, or liquid or solid stool
  • Feeling of incomplete emptying/ Straining
  • Urgency
  • Digital evacuation to complete defecation
  • Splinting, or pushing on or around the vagina or perineum, to start or complete defecation

Reproductive System (26 decks)

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