Pelvic Organ Prolapse Flashcards
What is prolapse?
Protrusion of an organ or structure beyond its normal anatomical confines
What is female POP?
The descent of the pelvic organs towards or through the vagina
What are some dynamic organs of the pelvic cavity?
Rectum Anus Uterus Bladder Urethra Vagina
Which structures make up the endo-pelvic fascia?
Uterosacral ligaments
Pubocervical fascia
Rectovaginal fascia
What is the pelvic diaphragm?
Levator ani
Coccygeus
Layer of striated muscles with its fascial coverings
What is the urogenital diaphragm?
The superficial & deep transverse perineal muscles with their fascial coverings
What are the 3 layers of the pelvic floor?
Endo-pelvic fascia
Pelvic diaphragm
Urogenital diaphragm
What structure provides the main support to the anterior vaginal wall?
Pubocervical fascia
Is the rectovaginal fascia rigid or elastic?
Elastic
Where does the pubocervical fascia tend to break?
At lateral attachments to the arcus tendineus fascia pelvis
Or immediately in front of cervix
Where does the utero-sacral fascia tend to break?
Tend to break medially (around the cervix)
What could an upper defect in the rectovaginal fascia lead to?
Probably enterocele
What would a lower defect in the rectovaginal fascia lead to?
Perineal body descent
Rectocele
What are some risk factors for pelvic organ prolapse?
Pregnancy and vaginal birth
Advancing age
Obesity
Previous pelvic surgery
What are some factors of pregnancy which could increase risk of prolapse?
Forceps delivery
Large baby
Prolonged second stage
What are some previous pelvic surgeries which could increase risk of pelvic organ prolapse?
Continence procedures
(Burch colposuspension)
Hysterectomy
What kind of prolapse can weight lifting, high impact aerobics and long distance running predispose you to?
Urogenital
What is a 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 a 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 in women with vaginal pelvic organ prolapse?
Seeing one Bulging/protruding sensation Pressure Heaviness Difficulty inserting tampons
What are some typical symptoms in women with urinary pelvic organ prolapse?
Urinary Incontinence Frequency/ Urgency Weak or prolonged urinary stream Feeling of incomplete emptying Manual reduction of prolapse to start or complete voiding
What are the typical symptoms in women with bowel pelvic organ prolapse?
Incontinence of flatus
Irregular stool consistency
Urgency
Difficulty completing defecation
What are some objective assessments used for pelvic organ prolapse?
POPQ score
Baden-Walker-Halfway Grading
How would a suspected ureteric obstruction in pelvic organ prolapse be investigated?
IVU
Renal USS
What are some possible uses of urodynamics in pelvic organ prolapse?
Concurrent UI or to exclude Occult SI
What are some good investigations for assessing fascial defects?
USS
MRI
What are some steps which can be taken to reduce risk of pelvic organ prolapse?
Avoid constipation
Manage chest pathologies well
Smaller family size
What is the goal of pelvic floor muscle training (PFMT)?
Increase pelvic floor strength and bulk to relieve tension on the ligaments
What are some exclusions for vaginal pessaries?
Previous POP surgery
Unable to retain pessary for 2 weeks
What is a vaginal pessary?
Plastic device in the shape of a circle that fits into your vagina to support uterine prolapse
