pelvic organ prolapse Flashcards
what are the three layers of the pelvic floor ?
endo-pelvic fascia - furbo-muscular connective tissue, surrounds various structure
pelvic diaphragm - striated muscles with facial coverings
urogenital diaphragm - superficial and deep transverse muscles with their fascial coverings
what are the main ligaments of the endo-pelvic fascia ?
uterosacral/cardinal ligament - break medially
pubocervical fascia - provide main support to ant. vaginal wall, break laterally
rectovaginal fascia - break centrally
what are risk factors for pelvic organ prolapse ?
pregnancy and vaginal birth - forceps, big baby, prolonged second stage
advanced age
obesity
previous pelvic floor surgery
hormones, constipation, exercise(weights, running)
what is a urethrocele ?
prolapse of lower anterior vaginal wall
involves urethra only
what is a cystocele ?
prolapse of upper anterior vaginal wall
involves bladder
what is a uterovaginal prolapse ?
prolapse of uterus, cervix and upper vagina
what is an enterocoele ?
prolapse of upper posterior wall of vagina
contains loops of small bowel
what is a rectocele ?
prolapse of lower posterior wall
involves rectum bulging forward into vagina
what are vaginal symptoms of pelvic organ prolapse ?
sensation of bulging seeing or feeling protrusion pressure heaviness difficulty inserting tampons
what are urinary symptoms of pelvic organ prolapse ?
incontinence
frequency/urgency
weak or prolonged stream
manual reduction of prolapse to start
what are bowel symptoms of pelvic organ prolapse ?
incontinence or flatus, liquid/solid stool
feeling of incomplete emptying
urgency
digital evacuation to complete defecation
splinting
how is pelvic organ prolapse scored ?
POP-Q score
how do you investigate pelvic organ prolapse ?
USS/MRI
urodynamics
IVU or renal USS
how do you treat pelvic organ prolapse ?
physiotherapy - PFMT
pessaries
surgery
