Prolapse Flashcards
What is the definition of a pelvic organ prolapse (POP)?
Protrusion of pelvic structures into vaginal canal or through introitus (opening of vagina)
What percentage of parous women will have some POP? What percentage will be symptomatic?
50% of parous women get POP, 10-20% will be symptomatic
How many layers of support are there for pelvic organs?
3 layers
Name 4 types of POP and what organs are affected in each prolapse
Anterior vaginal wall descent - cystocoele (bladder prolapse)
Apical descent - uterine/vault prolapse (uterus affected) +/- enterocoele (POD outpouches containing small or large bowel)
Posterior vaginal wall descent - rectocoele (rectum)
Procidentia - complete prolapse of uterus beyond hymen
Name 5 risk factors for developing POP
Parity/vaginal delivery
Age
Menopause
Previous Sx for POP or hysterectomy
Congenital defects (connective tissue disease, collagen defects, spina bifida)
Lifestyle (lifting, high impact activities)
Chronic disease - cough, constipation, diabetes
Obesity
Smoking
What is the recurrence rate for POP after Sx? What location does the recurrent POP usually occur in relative to the first POP?
10-30%, often at site opposite original one (surgery pulls too hard in the other direction)
Name 4 potential symptoms of someone with POP
Protruding bulge from vagina
Pelvic or back pain after prolonged standing
Ulceration, bleeding from prolapsed vaginal skin
Problems with urinating or defecating (either obstruction or incontinence)
What position is useful for doing a speculum examination for POP?
Left lateral position (Sims speculum examination)
What is the name of the most widely used scale for assessing POP on examination?
POP-Q scale
How do you tell the difference between a rectocoele and enterocoele on examination?
Can see waves of peristalsis in enterocoele
Can see finger going up prolapse of rectocoele on DRE
Name 3 complications of a POP
Bleeding Infection Incontinence Obstruction Ischaemia and necrosis
What are the 3 main approaches to treatment of a POP?
No treatment (watch and wait)
Conservative treatment
Surgical treatment
Name 4 interventions for conservative treatment of a POP
Pelvic floor exercises/physio
Oestrogen replacement
Lifestyle changes (weight loss, smoking cessation)
Pessary
How does a pessary work? Name 2 side effects
Acts as a supporting device to restore pelvic organ to normal position.
SE - UTI/vaginal infections, vaginal erosions or discharge, bleeding
What are the 3 main approaches for surgery of a POP?
Vaginal
Abdominal
Laparoscopic
