Pelvic Organ Prolapse Flashcards
What causes pelvic organ prolapse?
Vaginal birth
COPD or other heavy coughing disease with weak pelvic muscles
Typical presentation?
” 58 y/o multiparous woman presents with pelvic heaviness and feeling as though something is protruding. She notices it after lifting something heavy and is having difficulty passing urine. She is fat and a heavy smoker. “
The heavy smoker indicates COPD and multiparity –> pelvic floor weakness
What systems are affected by pelvic organ prolapse?
Vagina
Urinary
Bowel
Vaginal symptoms?
Heaviness
Bulge
May present as “difficulty inserting tampons”
Urinary symptoms?
Dysuria
Inconctinence
Poor voiding
Bowel?
Flatus
Straining
Needs to push stomach to initiate
Investigation?
Vaginal exam
Urodynamics
MRI
When are urodynamics done?
Incontinence
What scale is used to assess extent of prolapse?
Baden-walker-halfway grading
What is the baden-walker-halfway grading?
0 - level of ischial spines 1 - halfway to hymen 2 - to the hymen 3 - halfway past hymen 4 - maximum descent
Non-surgical management?
Physiotherapy 1st line
- Pelvic floor muscle training (PFMT)
- > kegels
Pharma
- Control COPD
What surgical management is there for pelvic organ prolapse?
Insertion of pessary
- Supports uterus
Reconstructive surgery
When is reconstructive surgery 1st line?
Sexually active
