Pelvic Organ Prolapse Flashcards
What is a prolapse?
The protrusion of an organ or structure beyond its normal anatomical confines (in females this is the descent of the pelvic organs towards or through the vagina)
Name the three layers of the pelvic floor
- Endo-pelvic fascia: connective tissue
- Pelvic diaphragm: levator ani and coccygeus
- Urogenital diaphragm: superficial and deep transverse perineal muscles + fascia
Describe the location of the utero-sacral complex
- Medial to the uterus, cervix, lateral vaginal fornices and pubocervical + rectovaginal fascia
- Lateral to the sacrum and the fascia overlying the Piriformis muscle
Describe the borders of the pubocervical fascia
- Central: merges with the base of the cardinal ligaments and cervix
- Laterally: arcus tendineus fascia pelvis
- Distally: urogenital diaphagm
Describe the borders of the rectovaginal fascia
- Centrally: merges with the base of the uterosacral ligaments and peritoneum
- Laterally: fuses with fascia over the levatator ani
- Distally: firmly attached to the perineal body
Name the three levels of endopelvic support
- Level 1: utero-sacral and cardinal ligaments
- Level 2: para-vagina to arcus tendineus fascia and rectovaginal fascia
- Level 3: urogenital diaphragm and perineal body
What are the risk factors for POP?
- Pregnancy and vaginal birth
- Advancing age
- Obesity
- Previous pelvic surgery
- Hormonal factors
- Quality of connective tissue
- Constipation
- Occupation with heavy lifting
- Exercise
What is an urethrocele?
Prolapse of the lower anterior vaginal wall involving the urethra only
What is a cystocele?
Prolapse of the upper anterior vaginal wall involving the bladder
What is an uterovaginal prolapse?
-Prolapse of the uterus, cervix and upper vagina
What is an enterocele?
Prolapse of the upper posterior wall of the vagina usually containing loops of small bowel
What is a rectocele?
Prolapse of the lower posterior wall of the vagina involving the rectum bulging forwards into the vagina
What are the typical symptoms of pelvic organ prolapse?
- Sensation/seeing/feeling a bulge or protrusion
- Pressure
- Heavinesss
- Difficulty in inserting tampons
- Urinary incontinence
- Frequency/urgency
- Weak or prolonged urinary stream
- Hesitancy
- Feeling of incomplete emptying
- Manual reduction of prolapse to start or complete voiding
- Incontinence
- Incomplete bowel emptying/ straining
- Urgency
- Digital evacuation to complete defecation
- Splinting or pushing on or around the vagina or perineum to start or complete defecation
How can POP be assessed?
- Examination
- Quality of life
- Baden Walker Halfawy grading
- POPQ score
How can POP be investigated?
- USS/MRI
- Urodynamics
- IVU or renal USS
