Pelvic organ prolapse Flashcards

1
Q

What is a prolapse?

A

Protrusion of an organ or structure beyond its normal anatomical confines

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2
Q

What is female pelvic organ prolapse?

A

Descent of pelvic organs towards or through the vagina

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3
Q

Are nulliparous or multiparous women more likely to get pelvic organ prolapse?

A

Multiparous

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4
Q

What is the pelvic floor?

A

The bottom surface of the pelvic cavity

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5
Q

What is the purpose of the pelvic floor?

A

Keeps pelvic viscera in position at rest and when there is increased intra-abdominal pressure

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6
Q

What are the 3 layers of the pelvic floor?

A

Endo-pelvic fascia
Pelvic diaphragm
Urogenital diaphragm

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7
Q

What is the endo-pelvic fascia?

A

Network of fibro-muscular connective tissue that has a hammock-like configuration and surrounds various visceral structures

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8
Q

What structures male up the endo-pelvic fascia?

A

Uterosacral ligaments
Pubocervical fascia
Rectovaginal fascia

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9
Q

What is the pelvic diaphragm?

A

Layer of striated muscles with fascial coverings

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10
Q

What structures make up the pelvic diaphragm?

A

Levator ani

Coccygeus

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11
Q

What is the urogenital diaphragm?

A

Superficial and deep transverse perineal muscles with their fascial coverings

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12
Q

What is the anatomical position of the utero-sacral ligament?

A

Medial to the uterus, cervix, lateral vaginal fornices and pubocervical and rectovaginal fascia
Lateral to sacrum and fascia overlying piriformis muscle

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13
Q

How can the utero-sacral ligament be palpated?

A

Down traction on the cervix

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14
Q

What does the utero-sacral ligament provide?

A

Limited side-side movement of the cervix

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15
Q

Which part of the utero-sacral ligament tends to break?

A

Medial part

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16
Q

Why is it important that the ligament normally breaks medially?

A

Allows the surgeon to access it vaginally

17
Q

What are the 3 supports of the pubocervical fascia?

A

Centrally - merges with the base of cardinal ligaments and cervix
Laterally - arcus tendineus fascia pelvis
Distally - Urogenital diaphragm

18
Q

Where does the pubocervical fascia tend to break?

A

Lateral attachments or immediately in front of cervix

19
Q

What tissue makes up the rectovaginal fascia?

A

Fibro-musculo-elastic tissue

20
Q

What are the 3 supports for the rectovaginal fascia?

A

Centrally merge with base of the cardinal/uterosacral ligaments and peritoneum
Laterally fuses with fascia over levator ani
Distally attaches firmly to the perineal body

21
Q

Where does the rectovaginal fascia tend to break?

A

Centrally
If upper defect - enterocele
If lower defect - perineal body descent and rectocele

22
Q

What is enterocele?

A

Descent of the small intestine into the vagina

23
Q

What is rectocele?

A

Protrusion of the rectum into the vagina

24
Q

What are risk factors of pelvic organ prolapse?

A
Forceps delivery of vaginal birth
Large baby - over 4500 grams
Prolonged second stage of labour
Advancing age
Obesity
Previous pelvic surgery
Hormonal factors
Constipation
Occupation with heavy lifting
Some forms of exercise
25
What pelvic surgery increases risk of pelvic organ prolapse?
Continence procedures | Hysterectomy
26
What is urethrocele?
Prolapse of the lower anterior vaginal wall involving the urethra only
27
What is a cystocele?
Prolapse of the upper anterior vaginal wall involving the bladder
28
What is uterovaginal prolapse?
Term used to describe prolapse of the uterus, cervix, and upper vagina
29
What are typical vaginal symptoms in women with pelvic organ prolapse?
``` Sensation of bulge or protrusion Seeing or feeling bulge or protrusion Pressure Heaviness Difficulty inserting tampons ```
30
What are typical urinary symptoms in women with pelvic organ prolapse?
Urinary incontinence Frequency/urgency Weak or prolonged urinary stream/feeling of incomplete emptying Manual reduction of prolapse to start or complete voiding
31
What are typical bowel symptoms in women with pelvic organ prolapse?
Incontinence of flatus or liquid stool Feeling of incomplete emptying Urgency Digital evacuation to complete defecation
32
What is the gold standard assessment of pelvic organ prolapse?
POPQ score
33
What investigations can be done into pelvic organ prolapse?
USS or MRI to allow identification of fascial defects Urodynamics IVU or renal USS
34
How can pelvic organ prolapse be prevented?
Avoid constipation Effective management of chronic chest pathology Smaller family size Improvements in antenatal and intra-partum care
35
How can pelvic organ prolapse be treated?
Physiotherapy - pelvic floor muscle training | Surgical treatment
36
What are factors of pelvic floor muscle training that make it an effective option?
Increase pelvic floor strength and bulk leading to decreased tension on ligaments Improves cases of mild prolapse Effecting in young women who have not completed their family
37
What are negative factors of pelvic floor muscle training?
No role in advanced diseases | Cannot treat fascial defects