Pelvic Organ Prolapse Flashcards
What is the meaning of Pelvic Organ Prolapse?
- Protrusion of the pelvic organs
- into or *out
- of the vaginal canal.
protrusion means to nudge to budge, moves beyond its normal confines.
What organs does POP involve?
- urethra
- bladder
- rectum
- intestine
-uterus
What are the normal support structures?
- Ligaments
2. Anterior and posterior vaginal walls
Ligaments supporting the uterus:
What is uterine prolapse?
What is procidentia?
- Transverse Cervical Ligaments
from the cervix and
upper vagina to the
pelvic side wall.
-Uterosacral Ligaments
from cervix and upper
vagina to sacrum.
Imagine if this ligaments break, the uterus will go into the vagina =uterine prolapse
(Varying degrees of prolapse of both the uterus and cervix can occur.
The most advanced grade is called procidentia, meaning the uterus and cervix are completely out of the vagina)
Anterior and posterior vaginal walls support:
- Pubo-cervical fascia: connective tissue between the vagina and the bladder.
- Rectovaginal fascia: connective tissue between the recctum and the vagina.
Damage to the fascia results in prolapse.
What is the aetiology of POP?
- Genetic
- family history suggestive of poor collagen. - Parity
- uncommon in nullipara - Vaginal childbirth.
- Hysterectomy ( can result in Vaginal Vault Prolapse- prolapse of the vaginal apex after hysterectomy)
- Oestrogen deficiency
- menopause - Chronically increased intra-abdominal pressure
- chronic cough
- obesity - Neurological
- spina bifida in children
What are the general signs and symptoms of POP?
- Feeling of a lump or a bump in vagina.
- Feeling of heaviness or pelvic pressure.
- LAP or LBP
-Usually not painful, pts will describe varying degrees of discomfort.
What are the sexual symptoms of POP?
- Dyspareunia
- Vaginal dryness
-Coital incontinence
What are the symptoms of POP that happen anteriorly? (Bladder, urethra)
Term for:
Herniation of the anterior vaginal wall with the underlying bladder and urethra
- Stress incontinence
- Urgency
- Urge incontinence
- Straining to void.
- Post micturition dribbling
- Poor stream
- Double voiding
- Incomplete emptying
- Vaginal pressure or manual replacement to void
- Recurrent UTI
(CYSTOCELE)
What are the symptoms of POP that happens posteriorly? (Rectum)
Term:
Herniation of the posterior vaginal wall with the underlying rectum
- Pelvic pressure
- Constipation
- Defaecatory difficulty
- Incomplete bowel emptying
- Faecal incontinence
- Digitation to aid defaecation
(RECTOCELE)
Grading of pelvic organ prolapse:
-Baden Walker Grading:
Grade 1- halfway down the vagina
Grade 2- to the hymenal ring
Grade 3- 2cm or less beyond the hymenal ring
Grade 4- More than 2 cm beyond the hymenal ring (maximal descent)
What is enterocele???
- Herniation of peritonium
- with or without small bowel
- between the rectum and uterus
- at the top of the vagina
What is the medical management of POP?
- Pelvic floor exercise
- Pessary Ring
- Topical oestrogen
-Modifiable factors:
Healthy diet and excercise
Reduce constipation
Reduce chronic cough
Indications for medical managemnet over surgical:
- Patient’s wish
- Therapeutic test
- Childberaing not complete
- Medically unfit
- While awaiting surgery
What is the surgical management of POP?
- Anterior Repair ( anterior colporraphy)
- Posterior Repair/ Posterior Colpo-Perineorrphy
- Vaginal Hysterectomy and Vault Suspension
- Sacrospinous Fixation
- Sacrocolpopexy
- Vaginal Mesh Procedures
