Prolapse

Question 1

When does prolapse occur?

Answer 1

When the weakness of supporting muscles allows for pelvic organs to protrude within the vagina

Question 2

Causes of pelvic floor muscle weakness?

Answer 2

• Congenital
• Prolonged labour
• Trauma from instrumental delivery
• Lack of postnatal pelvic floor exercises
• Obesity
• Chronic cough
• Constipation

Question 3

What are the types of prolapse?

Answer 3

• Cystocele
• Rectocele
• Enterocele
• Uterine prolapse
• Vaginal Vault prolapse

Question 4

What is a cystocele?

Answer 4

Bulging of the anterior wall attached to bladder - anterior wall prolapse

Question 5

What are the Sx specific to a cystocele?

Answer 5

Frequency, dysuria, incomplete bladder emptying, urinary retention ( if causes urethra to kink)

Question 6

What other prolapse is a cystocele associated with?

Answer 6

Urethral prolapse

Question 7

What is a rectocele?

Answer 7

Lower posterior wall prolapse - bulge of Lower posterior wall through the elevator ani

Question 8

What are the Sx specific to rectocele?

Answer 8

Often asymptomatic but women may have to reduce the hernia in order to open their bowels.

• constipation
• difficulty with defaecation

Question 9

What is an enterocoele?

Answer 9

Prolapse of the upper posterior wall. The vaginal wall may contain loops of intestine in the pouch of Douglas.

Question 10

What is a uterine prolapse?

Answer 10

Protrusion of the uterus downwards into the vagina

Question 11

What is vaginal vault prolapse?

Answer 11

Protrusion of the vaginal vault (from hysterectomy) into the vagina.

Question 12

How do you grade prolapses?

Answer 12

First, second, third ad fourth (Procidentia) degree

Question 13

What is meant by first degree prolapse?

Answer 13

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

Question 14

What is meant by second degree prolapse?

Answer 14

The lowest part of the prolapse extends to the level of the introitus

Question 15

What is meant by third degree prolapse?

Answer 15

The lowest part of the prolapse extends through the introitus and through the vagina

Question 16

What is meant by fourth degree/procidentia prolapse?

Answer 16

The uterus lies outside of the vagina

Question 17

Symptoms of prolapse?

Answer 17

May my asymptomatic

• Dragging sensation
• discomfort
• Felling a lump ‘coming down’
• dyspareunia
• Backache

Question 18

What ca be done to try and prevent prolapse?

Answer 18

Lower parity
Better obstetric practices
Pelvic floor exercises

Question 19

Which speculum is used for examination of prolapse?

Answer 19

SIMS SPECULUM (use when woman is in the left lateral position)

Question 20

What is the conservative management of prolapse?

Answer 20

Mild disease:

• decrease intra-abdominal pressure - lose weight, stop straining
• smoking cessation
• improve muscle tone - exercises and physio

Question 21

What treatment may be used if surgery is contraindicated or people are unfit for surgery?

Answer 21

Pessaries

Question 22

How often should pessaries be changed?

Answer 22

Every 6 months

Question 23

If a woman with a pessary is post-menopausal what else should be prescribed and why?

Answer 23

Vaginal oestrogen to prevent vaginal erosion

Question 24

What is the most common pessary used?

Answer 24

Ring pessary

Question 25

Where are ring pessaries placed?

Answer 25

Between the posterior aspect of the pubic symphysis and posterior fornix of the vagina

Question 26

What other types of pessaries other than ring are there>

Answer 26

Shelves, cubes, doughnut

Question 27

When is surgery indicated?

Answer 27

When the symptoms are severe, the woman is sexually active and pessaries have failed.

Question 28

What is the downside of a pessary?

Answer 28

They affect sexual function

Question 29

How o you treat post-hysterectomy vaginal vault prolapse?

Answer 29

Sacrocolpoplexy

Question 30

what repair surgeries are there?

Answer 30

Anterior and posterior wall repairs (and colposuspension)