Prolapse Flashcards
Types of prolapse?
- Cystocele
- Rectocele
- Enterocele
- Uterine prolapse
What is the most common type of prolapse?
Cytocele
What happens in cytocele?
Bladder drops into vagina
What is rectocele?
Rectum bulges into or out of vagina
Enterocele?
Small intestine bulges into the wall of vagina
Uterine prolapse?
Uterus into 1) Vagina 2)Introitus 3)Outside vagina Procidentia: entirely outside vagina
RFs for prolapse?
- 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
Presentation of prolapse?
- Bulging, pressure, feeling of a mass
- Difficulty voiding or defaecating
- Incomplete emptying
- Splinting vaginal wall
- Difficulty inserting tampon
- Pain with intercourse
What is splinting vaginal wall?
Person has to press fingers on vagina to evacuate stool
Conservative management of prolapse?
- Reassure
- Avoid heavy lifting, lose weight, stop smoking, reduce constipation
- Vaginal oestrogens if symptomatic with atrophic vaginitis
Physical management of prolapse?
- 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
Who are pessaries suitable for?
Women unfit for surgery
- Relief of symptoms whilst waiting for surgery
- If further pregnancies planned or they are pregnant
1st degree prolapse?
In vagina
2nd degree uterovaginal prolapse?
At introitus
3rd degree uterovaginal prolapse?
Outside vagina
4th degree uterovaginal prolapse?
Entiely outside vagina
Investigation of Prolapse?
POP-Q
POP Q involves?
Patinet straining in 6 specific sites are evaluated, at rest 3 measured
-measure each site inrelation to hymenal ring (cm) which is fixed
Zero point of reference in POP-Q?
Hymenal ring
If site is above hymen for POP Q what number do you assign it?
Negative
Positive if below hymen
1st line for OAB and UI?
All immediate release
Oxybutynin
Tolterodine
Propiverine
2nd line AM treatment for OAB?
- Trospium
- Oxybutynin (extended rlease)
- Darifenacin
Treatment of uterovaginal prolapse?
Conservative- reassure
Vaginal oestrogens- only if symptomatic AV
Repairing prolapses in surgery?
- Vaginal hysterectomy
- Manchester repair
- Sacrospinous fixation
- Abdo/laparo sacrolpopexy
- Mesh techniques
- Colpocleisis
Mesh of choice in prolapse?
Dynamesh
What is Manchester repair?
Cervix amputated, uterosacral ligaments shortened
