Pelvic Relaxation

Question 1

in which position should the diagnosis of pelvic relaxation be made?

Answer 1

in both the supine and standing position (helps to determine the the severity of the prolapse)

Question 2

when prolapse becomes symptomatic, treatment is warranted with surgery or what kind of device?

Answer 2

pessary

Question 3

the pelvic diaphragm is made up of what two muscles?

Answer 3

levator ani and the coccygeal muscles

Question 4

define prolapse

Answer 4

the failure of pelvic musculature to maintain the pelvic organs in their normal position

Question 5

what are the three types of prolapse? what are some common examples?

Answer 5

anterior, apical and posterior; anterior (cystocele, cystourethrocele), apical (vaginal prolapse, uterocele), posterior (rectocele, enterocele)

Question 6

in terms of classification of prolapse and the organ displacement, the higher the grade indicates what?

Answer 6

the further down the organs have prolapsed from within the pelvis (grade 1: to the level of the ischial spine; grade IV: past introitus)

Question 7

name at least 3 risk factors for prolapse

Answer 7

increased abdominal pressure (cough, obesity, heavy lifting), loss of innervation, advancing age, chronic obstruction, menopause, parity.

Question 8

what is “splinting to defecate”

Answer 8

inserting a finger into the vagina to push the bulge in to assist with the passage of stool (this is a symptom you can look for in pts w/prolapse)

Question 9

what is the treatment for asymptomatic prolapse?

Answer 9

usually requires follow-up, but no immediate intervention is needed - can try pelvic strengthening exercises and/or HRT. symptomatic prolapse is usually treated surgically or with pessary device.