Prolapse Flashcards
1
Q
Types of prolapse?
A
- Cystocele
- Rectocele
- Enterocele
- Uterine prolapse
2
Q
What is the most common type of prolapse?
A
Cytocele
3
Q
What happens in cytocele?
A
Bladder drops into vagina
4
Q
What is rectocele?
A
Rectum bulges into or out of vagina
5
Q
Enterocele?
A
Small intestine bulges into the wall of vagina
6
Q
Uterine prolapse?
A
Uterus into 1) Vagina 2)Introitus 3)Outside vagina Procidentia: entirely outside vagina
7
Q
RFs for prolapse?
A
- Ageing
- Prior pelvic surgery (hysterectomy)
- Menopause & hypo-oestrogenism
- Loss of muscular tone
- Multiple vaginal births
- Obesity
- Chronic constipation, coughing or heavy lifting
- Uterine fibroids
- Fam Hx
- Connective tissue disorders eg Marfan’s or Ehlers Danlos
8
Q
Presentation of prolapse?
A
- Bulging, pressure, feeling of a mass
- Difficulty voiding or defaecating
- Incomplete emptying
- Splinting vaginal wall
- Difficulty inserting tampon
- Pain with intercourse
9
Q
What is splinting vaginal wall?
A
Person has to press fingers on vagina to evacuate stool
10
Q
Conservative management of prolapse?
A
- Reassure
- Avoid heavy lifting, lose weight, stop smoking, reduce constipation
- Vaginal oestrogens if symptomatic with atrophic vaginitis
11
Q
Physical management of prolapse?
A
- Pelvic floor muscle exercises(kegel) are effective in prolapse when it is up to vaginal entry
- Min 4-6 months of supervised PFME training
-Even with more significant prolapse PFME may help with symptoms
12
Q
Who are pessaries suitable for?
A
Women unfit for surgery
- Relief of symptoms whilst waiting for surgery
- If further pregnancies planned or they are pregnant
13
Q
1st degree prolapse?
A
In vagina
14
Q
2nd degree uterovaginal prolapse?
A
At introitus
15
Q
3rd degree uterovaginal prolapse?
A
Outside vagina
