Pelvic organ prolapse Flashcards
What is a prolapse?
Protrusion of an organ or structure beyond its normal anatomical confines
What is female pelvic organ prolapse?
Descent of pelvic organs towards or through the vagina
Are nulliparous or multiparous women more likely to get pelvic organ prolapse?
Multiparous
What is the pelvic floor?
The bottom surface of the pelvic cavity
What is the purpose of the pelvic floor?
Keeps pelvic viscera in position at rest and when there is increased intra-abdominal pressure
What are the 3 layers of the pelvic floor?
Endo-pelvic fascia
Pelvic diaphragm
Urogenital diaphragm
What is the endo-pelvic fascia?
Network of fibro-muscular connective tissue that has a hammock-like configuration and surrounds various visceral structures
What structures male up the endo-pelvic fascia?
Uterosacral ligaments
Pubocervical fascia
Rectovaginal fascia
What is the pelvic diaphragm?
Layer of striated muscles with fascial coverings
What structures make up the pelvic diaphragm?
Levator ani
Coccygeus
What is the urogenital diaphragm?
Superficial and deep transverse perineal muscles with their fascial coverings
What is the anatomical position of the utero-sacral ligament?
Medial to the uterus, cervix, lateral vaginal fornices and pubocervical and rectovaginal fascia
Lateral to sacrum and fascia overlying piriformis muscle
How can the utero-sacral ligament be palpated?
Down traction on the cervix
What does the utero-sacral ligament provide?
Limited side-side movement of the cervix
Which part of the utero-sacral ligament tends to break?
Medial part
Why is it important that the ligament normally breaks medially?
Allows the surgeon to access it vaginally
What are the 3 supports of the pubocervical fascia?
Centrally - merges with the base of cardinal ligaments and cervix
Laterally - arcus tendineus fascia pelvis
Distally - Urogenital diaphragm
Where does the pubocervical fascia tend to break?
Lateral attachments or immediately in front of cervix
What tissue makes up the rectovaginal fascia?
Fibro-musculo-elastic tissue
What are the 3 supports for the rectovaginal fascia?
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
Where does the rectovaginal fascia tend to break?
Centrally
If upper defect - enterocele
If lower defect - perineal body descent and rectocele
What is enterocele?
Descent of the small intestine into the vagina
What is rectocele?
Protrusion of the rectum into the vagina
What are risk factors of pelvic organ prolapse?
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