pelvic organ prolapse

Question 1

prolapse

Answer 1

protrusion of an organ or structure beyond its normal anatomical confines

Question 2

female POP

Answer 2

refers to descent of pelvic organs towards or through the vagina

Question 3

3 layers of pelvic floor

Answer 3

endo-pelvic fascia
pelvic diaphragm
urogenital diaphragm

Question 4

risk factors for POP

Answer 4

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

Question 5

urethrocele

Answer 5

prolapse of lower anterior vaginal wall involving urethra onlu

Question 6

cystocele

Answer 6

prolapse of upper anterior vaginal wall involving the bladder

Question 7

uterovaginal prolapse

Answer 7

prolapse of uterus, cervix and upper vagina

Question 8

enterocele

Answer 8

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

Question 9

rectocele

Answer 9

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

Question 10

symptoms in women with POP: vaginal

Answer 10

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

Question 11

symptoms in women with POP: urinary

Answer 11

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

Question 12

symptoms in women with POP: bowel

Answer 12

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

Question 13

assessment of POP

Answer 13

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

Question 14

objective assessment of POP

Answer 14

Baden-walker-halfawy grading

POPQ score

Question 15

POP investigations

Answer 15

USS/MRI
urodynamics
IVU or renal USS

Question 16

prevention of POP

Answer 16

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

Question 17

treatment of POP: physiotherapy

Answer 17

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

Question 18

treatment of POP: current vaginal pessaries

Answer 18

silicone, rubber or plastic

silicone is advantageous

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

Question 19

treatment of POP: surgical

Answer 19

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