Prolapse Flashcards
What is a prolapse
weakness of supporting structures allowing the pelvic organs to protrude w/in the vagina
What are the causes of prolapse?
Congenital prolonged labour trauma from instrumental delivery lack of postnatal pelvic exercises obesity chronic cough constipation poor perineal
What are the types of prolapse, explain what causes them?
cystocele - anterior wall of the vagina and bladder attached to it bulge
rectocele - lower posterior wall attached to the rectum may bulge through weak elevator ani
enterocele - bulges of the upper posterior vaginal wall may contain loops of intestine from the pouch of Douglas
uterine prolapse - protrusion of the uterus downwards into the vagina taking with it the cervix and upper vagina
What is this?
https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwj91IDakpPeAhWLxYUKHb9QCKcQjRx6BAgBEAU&url=https%3A%2F%2Fwww.austinurogynecology.com%2Fcystocele%2F&psig=AOvVaw3jXuH8bIj173mMtjh6shVv&ust=1540060531774150
cystocele
What is this?
https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwiswPH_kpPeAhVRbBoKHYQ2CzIQjRx6BAgBEAU&url=https%3A%2F%2Fmy.clevelandclinic.org%2Fhealth%2Fdiseases%2F17415-rectocoele&psig=AOvVaw3GS_PqfWn9otgy7jYHz3xQ&ust=1540060608451256
rectocele
What is this?
https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwiswPH_kpPeAhVRbBoKHYQ2CzIQjRx6BAgBEAU&url=https%3A%2F%2Fmy.clevelandclinic.org%2Fhealth%2Fdiseases%2F17415-rectocoele&psig=AOvVaw3GS_PqfWn9otgy7jYHz3xQ&ust=1540060608451256
Enterocele
What is this?
https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwiswPH_kpPeAhVRbBoKHYQ2CzIQjRx6BAgBEAU&url=https%3A%2F%2Fmy.clevelandclinic.org%2Fhealth%2Fdiseases%2F17415-rectocoele&psig=AOvVaw3GS_PqfWn9otgy7jYHz3xQ&ust=1540060608451256
Uterine prolapse
What is a 1st degree prolapse?
lowest part of prolapse descends halfway down the vaginal axis to the introitus
What is a 2nd degree prolapse?
lowest part of prolapse extends to the level of the introitus and through the introitus on straining
What is a 3rd degree prolapse?
lowest part of the prolapse extends throughout the introitus and outside the vagina
What is a cystocele?
Anterior wall of the vagina and bladder attached to it bulge, residual urine within cystocele may cause frequency and dysuria. Associated w urethral prolapse
What is a rectocele?
Lower posterior wall attached to the rectum, may bulge through weak levator ani
What is an enterocoele?
Bulges of the upper posterior vaginal wall may contain loops of intestine from the pouch of Douglas
What is a uterine prolapse?
Protrusion of the uterus downwards into the vagina, taking with it the cervix and upper vagina
What is procidentia?
4th degree
uterus lies outside the vagina
What are the symptoms for prolapse?
→ May be asymptomatic → Dragging sensation → Discomfort → Feeling of a lump ‘coming down’ → Dyspareunia → Backache
What are specific sx for cystocele?
- Urinary urgency and frequency
- Incomplete bladder emptying
- Urinary retention
What are specific sx for rectocele?
- Constipation
* Difficulty w defecation
How should an examination for prolapse be carried out?
i. Bimanual to exclude pelvic masses
ii. Examine for prolapse w the woman in left lateral position using Sims speculum (lying on left side)
iii. Inspect anterior and posterior walls for atrophy and descent
If prolapse isn’t obvious when the woman is in the left lateral position what can you do?
Ask the woman to strain or stand
What investigations may be appropriate for prolapse?
urodynamic studies
What is the conservative management for prolapse?
Mild disease may improve w in intra-abdominal pressure: Lose weight Stop smoking Stop straining Exercises/physio to improve muscle tone
What are the options for treatment of prolapse?
Conservative
Pessaries
Surgery
When are pessaries indicated?
if not having surgery
What are the most common types of pessary?
ring pessary
Where are pessaries placed?
between posterior aspect of symphysis pubis and posterior fornix of vagina
When is surgery indicateD?
if severe and sexually active and pessaries have failed
What types of surgery are there and what are they indicated for?
Marked uterine prolapse - hysterectomy
Post hysterectomy vault prolapse - sacrocalpoplexy
