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Women's Health > Prolapse > Flashcards

Prolapse Flashcards

1
Q

What is a prolapse

A

weakness of supporting structures allowing the pelvic organs to protrude w/in the vagina

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2
Q

What are the causes of prolapse?

A 
Congenital
prolonged labour
trauma from instrumental delivery
lack of postnatal pelvic exercises
obesity
chronic cough 
constipation
poor perineal
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3
Q

What are the types of prolapse, explain what causes them?

A

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

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4
Q

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

A

cystocele

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5
Q

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

A

rectocele

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6
Q

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

A

Enterocele

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7
Q

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

A

Uterine prolapse

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8
Q

What is a 1st degree prolapse?

A

lowest part of prolapse descends halfway down the vaginal axis to the introitus

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9
Q

What is a 2nd degree prolapse?

A

lowest part of prolapse extends to the level of the introitus and through the introitus on straining

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10
Q

What is a 3rd degree prolapse?

A

lowest part of the prolapse extends throughout the introitus and outside the vagina

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11
Q

What is a cystocele?

A

Anterior wall of the vagina and bladder attached to it bulge, residual urine within cystocele may cause frequency and dysuria. Associated w urethral prolapse

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12
Q

What is a rectocele?

A

Lower posterior wall attached to the rectum, may bulge through weak levator ani

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13
Q

What is an enterocoele?

A

Bulges of the upper posterior vaginal wall may contain loops of intestine from the pouch of Douglas

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14
Q

What is a uterine prolapse?

A

Protrusion of the uterus downwards into the vagina, taking with it the cervix and upper vagina

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15
Q

What is procidentia?

A

4th degree

uterus lies outside the vagina

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16
Q

What are the symptoms for prolapse?

A 
→	May be asymptomatic
→	Dragging sensation 
→	Discomfort
→	Feeling of a lump ‘coming down’
→	Dyspareunia 
→	Backache
17
Q

What are specific sx for cystocele?

A
  • Urinary urgency and frequency
  • Incomplete bladder emptying
  • Urinary retention
18
Q

What are specific sx for rectocele?

A
  • Constipation

* Difficulty w defecation

19
Q

How should an examination for prolapse be carried out?

A

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

20
Q

If prolapse isn’t obvious when the woman is in the left lateral position what can you do?

A

Ask the woman to strain or stand

21
Q

What investigations may be appropriate for prolapse?

A

urodynamic studies

22
Q

What is the conservative management for prolapse?

A 
Mild disease may improve w  in intra-abdominal pressure:
Lose weight 
Stop smoking 
Stop straining 
Exercises/physio to improve muscle tone
23
Q

What are the options for treatment of prolapse?

A

Conservative
Pessaries
Surgery

24
Q

When are pessaries indicated?

A

if not having surgery

25
Q

What are the most common types of pessary?

A

ring pessary

26
Q

Where are pessaries placed?

A

between posterior aspect of symphysis pubis and posterior fornix of vagina

27
Q

When is surgery indicateD?

A

if severe and sexually active and pessaries have failed

28
Q

What types of surgery are there and what are they indicated for?

A

Marked uterine prolapse - hysterectomy

Post hysterectomy vault prolapse - sacrocalpoplexy

Women's Health (65 decks)

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