Post-Menopausal Disorders : Pelvic Organ Prolapse

Question 1

What is Pelvic Organ Prolapse?

Answer 1

Descent of pelvic organs into the vagina.

Question 2

Aetiology of Pelvic Organ Prolapse.

Answer 2

Weakness and lengthening of the ligaments and muscles surrounding the uterus, rectum and bladder.

Question 3

Causes of Pelvic Organ Prolapse (6).

Answer 3

1. Multiple Vaginal Deliveries.
2. Instrumental, Prolonged, Traumatic Deliveries.
3. Advanced Age + Post-Menopausal.
4. Obesity.
5. Chronic Respiratory Disease : Coughing.
6. Chronic Coughing : Straining.

Question 4

What is Uterine Prolapse?

Answer 4

Uterus descends into the vagina.

Question 5

Grading of Uterine Prolapse (5).

Answer 5

1. 0 : Normal.
2. 1 : Lowest Part is more than 1cm above Introitus.
3. 2 : Lowest Part is within 1cm from Introitus.
4. 3 : Lowest Part is more than 1cm below Introitus.
5. 4 : Full Descent with Eversion of Vagina.

Question 6

What is Uterine Procidentia?

Answer 6

A prolapse extending beyond the Introitus.

Question 7

What is Vault Prolapse?

Answer 7

The top of the vagina (vault) descends into the vagina.

Question 8

Who is a Vault Prolapse more likely in?

Answer 8

Post-Hysterectomy Patients.

Question 9

What is a Rectocoele?

Answer 9

The rectum prolapses forward into the vagina.

Question 10

Aetiology of Rectocoele.

Answer 10

Defect in the posterior vaginal wall.

Question 11

Clinical Features of Rectocoele.

Answer 11

1. Constipation (Faecal Loading).
2. Urinary Retention (Compression of Urethra).
3. Palpable Lump in Vagina.

Question 12

What is a Cystocoele?

Answer 12

The bladder prolapses backwards into the vagina - with the urethra (urethrocoele).

Question 13

Aetiology of Cystocoele.

Answer 13

Defect in the anterior vaginal wall.

Question 14

Clinical Features of Pelvic Organ Prolapse.

Answer 14

1. Sensation of ‘Something Coming Down’ in Vagina.
2. Dragging/Heavy Sensation in Pelvis.
3. Urinary Symptoms.
4. Bowel Symptoms.
5. Sexual Dysfunction.

Question 15

Examination of Pelvic Organ Prolapse.

Answer 15

Sim’s (U) Speculum

Question 16

Management of Pelvic Organ Prolapse (3).

Answer 16

1. Conservative.
2. Vaginal Pessary.
3. Surgery.

Question 17

Conservative Management of Pelvic Organ Prolapse (5).

Answer 17

1. Physiotherapy.
2. Weight Loss.
3. Lifestyle Changes.
4. Treating Related Symptoms e.g. Incontinence.
5. Vaginal Oestrogen Cream.

Question 18

Maintenance with Vaginal Pessaries.

Answer 18

1. Remove, clean and change periodically (every 4 months).

2. Oestrogen Cream : can cause vaginal irritation and erosion over time.

Question 19

Surgical Management of Pelvic Organ Prolapse.

Answer 19

1. Definitive Management.

2. Mesh Repairs AVOID.