pelvic organ prolapse Flashcards

1
Q

prolapse

A

protrusion of an organ or structure beyond its normal anatomical confines

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2
Q

female POP

A

refers to descent of pelvic organs towards or through the vagina

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3
Q

3 layers of pelvic floor

A

endo-pelvic fascia
pelvic diaphragm
urogenital diaphragm

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4
Q

risk factors for POP

A

pregnancy + vaginal birth esp forceps, large baby, prolonged 2nd stage

advancing age
obesity 
prev pelvic surgery
hormonal factors
quality of connective tissue 
constipation 
occupation w heavy lifting
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5
Q

urethrocele

A

prolapse of lower anterior vaginal wall involving urethra onlu

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6
Q

cystocele

A

prolapse of upper anterior vaginal wall involving the bladder

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7
Q

uterovaginal prolapse

A

prolapse of uterus, cervix and upper vagina

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8
Q

enterocele

A

prolapse of upper posterior wall of vagina usually containing loops of small bowel

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9
Q

rectocele

A

prolapse of lower posterior wall of vagina involving the rectum bulging forwards into the vagina

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10
Q

symptoms in women with POP: vaginal

A
sensation of a bulge or protrusion 
seeing or feeling a bulge/protrusion 
pressure
heaviness
difficulty inserting tampons
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11
Q

symptoms in women with POP: urinary

A

urinary incontinence
frequency/urgency
weak or prolonged urinary stream/hesitancy/feeling incomplete emptying
manual reduction of prolapse to start or complete voiding

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12
Q

symptoms in women with POP: bowel

A

incontinence of flatus, or liquid or solid stools
feeling incomplete emptying/straining
urgency
digital evacuation to complete defecation
splinting or pushing on ar around vagina or perineum to start or complete defecation

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13
Q

assessment of POP

A

examination to exclude pelvic mass
record the position of examination: left lateral vs lothotomy vs standing
QOL

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14
Q

objective assessment of POP

A

Baden-walker-halfawy grading

POPQ score

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15
Q

POP investigations

A

USS/MRI
urodynamics
IVU or renal USS

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16
Q

prevention of POP

A

avoid constipation
effective management chronic chest pathology (COPD, asthma)
smaller family size

17
Q

treatment of POP: physiotherapy

A

pelvic floor muscle training (PFMT)
increase pelvic floor strength and bulk - relieve the tension on the ligaments
cases of mild prolapse

18
Q

treatment of POP: current vaginal pessaries

A

silicone, rubber or plastic

silicone is advantageous

  • long shelf-life
  • resistance to autoclaving and repeated cleaning
  • non-absorbent towards secretion and odors
  • inertness
  • hypoallergenic
19
Q

treatment of POP: surgical

A

aim: relieve symptoms, restore/maintain bladder + bowel function, maintain vaginal for sexual function