Pelvic Organ Prolapse

Question 1

what is it?

Answer 1

descent of pelvic organs into vagina

Question 2

pathophysiology?

Answer 2

weakness & lengthening of ligaments and muscles surrounding uterus, rectum and bladder

Question 3

types?

Answer 3

• urethrocele
• uterine prolapse
• vault prolapse
  
  • occurs w hysterectomy
  • top part of vagina descends into vagina
• rectocele
  
  • defect in posterior vaginal wall
  • assoc w constipation
• cystocele
  
  • defect in anterior vaginal wall

Question 4

risk factors?

Answer 4

• multiple vaginal deliveries/ prolonged or traumatic delivery
• increased age
• increased weight
• occupation–> heavy lifting
• previous pelvic surgery
• anything which increases intra-abdo pressure ie chronic cough

Question 5

presentation?

Answer 5

• feeling of “something coming down”
• dragging / heaviness
• urinary / bowel symptoms

Question 6

assessment?

Answer 6

• history
• examination
  
  • sim’s speculum examination
  • ask to cough or bear down in lithotomy position

Question 7

Mx?

Answer 7

1. conservative
   
   • weight loss, lifestyle modifications etc
   • PFMT
2. vaginal pessaries
   
   • silicone best one
3. surgery