POP-Q

Question 1

Outline the POP-Q quantification system

Answer 1

Describes prolapse by measured points in respect to hymen at full valsalva
Minus is above, plus is below
Aa - 3cm from external urethral meatus
Ba - leading edge of anterior prolapse
C - distal cervix/leading edge of vault scar (if hystx)
Ap - 3cm from hymen posteriorly
Bp - leading edge of posterior prolapse
D - posterior fornix (only if cervix present)
GH - length of genital hiatus - middle of external urethral meatus to posterior margin of hymen
PB - length of perineal body - posterior hymen to mid-anal opening
TVL - total vaginal length, point D to posterior hymen (not done at full valsalva)

Question 2

Give 3 reasons why the POPQ system is useful?

Answer 2

• system to objectively describe pelvic organ prolpase
• reduced inter-observer variability
• good for comparing pre and post treatment
• helps determine severity of POP to guide management

Question 3

a 58 y/o woman has both enterocoele and rectocele 10 yrs after a vaginal hysterectomy. Why has this happened?

Answer 3

• loss of level 1 supports (uterosacrals)
• age/decreased estrogen
• weakened pelvic floor
• increased intra-abdominal pressure
• connective tissue disease
• obesity

Question 4

How would you treat constipation in a woman with POP?

Answer 4

rule out causes
education and info
exercise
ensure good hydration
high fibre diet
laxatives:
- stool softeners - decussate, lactulose
- stimulants - Senna
- bulking - metamucil
- suppositories - enemas etc