Prolapse Flashcards
What is this describing?
Weakness of the supporting structures allows the pelvic organs to protrude within the vagina.
Pelvic organ prolapse
What are the four type of pelvic organ prolapse?
- Cystocele
- Rectocele
- Enterocele
- Uterine
What is this describing?
Anterior wall of vagina and bladder attached to it bulge, associated with frequency and dysuria.
Cystocele prolapse
What is this describing?
Lower posterior wall attached to rectum bulges through weak levator ani.
Rectocele prolapse
What is this describing?
Upper posterior wall may contain loops of intestine from the pouch of Douglas.
Enterocele prolapse
What is this describing?
Protrusion of uterus downwards into vagina, taking with it the cervix and upper vagina.
Uterine prolapse
What are the risk factors for developing prolapse?
- Parity - especially instrumental, vaginal delivery, and large infants
- Ehlers-Danlos syndrome
- Menopause
- Any cause of raised intra-abdominal pressure
- Obesity, chronic cough, constipation, heavy lifting, pelvic mass.
How can you prevent prolapse after childbirth?
Pelvic floor exercises
What is this a presentation of?
Dragging sensation, discomfort, feeling of a lump ‘coming down’, worse during standing and end of day, dyspareunia, lower urinary tract symptoms sometimes, constipation and difficult defecation sometimes.
Prolapse
How do you investigate prolapse?
- Examine using Sim’s speculum in left lateral position
2. Pelvic USS if pelvic mass suspected
What is the management for prolapse?
- Weight reduction, smoking cessation, pelvic floor exercises.
- Topical oestrogen if post-menopausal
- Ring pessaries if unfit/unwilling for surgery - changed every 6 months, affect sexual function
- Surgery if severe
What are the surgical repairs for cystocele, rectocele, and uterine prolapse?
- Cystocele - anterior repair
- Rectocele - posterior repair
- Uterine - hysterectomy/sarcohysteropexy
