Prolapse Flashcards
What are the layers of the pelvic floor?
Endometrial-pelvic fascia
Pelvic diaphragm= levator ani, coccygeus
URogenital diaphargm
What are the types of prolapse?
Urethrocoele Cystocoele Ureterovaginal Enterocoele Rectocoele Front or back wall
What are the risk factors for prolapse?
Pregnancy- ~50% parous women develop some prolapse VAginal birth- big baby, forceps, prolonged second stage Age Obesity Previous pelvic surgery Constipation Heavy lifting High impact exercise Weak pelvic floor
What are the stages of prolapse?
1= uterus in upper half vagina 2= uterus in lower half vagina 3= uterus protrudes out of vagina 4= uterus protrudes completely out of vagina
What ar the vaginal features of prolapse?
Sensation of bulge, protrusion, dragging, pressure
Difficulty inserting tampons
What are the urinary symptoms of prolapse?
Incontience
Frequency, urgency, hesitancy, poor stream
Incomplete emptying
Splinting of prolapse for voiding
What are the bowel symptoms of prolapse?
Incontinence
Straining, urgency
Incomplete emptying
Splinting of prolapse for voiding
How is prolapse assessed?
Symptoms
Quality of life
Examination
What are the management principles for prolapse?
Prevention
Pelvic floor muscle training
Pessaries
Surgery
How is prolapse prevented?
Avoid constipation
Management of chronic cough
Smaller family
Avoid heavy lifting, repetitive high impact exercise
What are the types of pessaries?
Ring
Shelf
What are the surgical management options for prolapse?
Sarcocolpopexy
Uterosacral ligament suspension
Sacrospinous ligament suspension
+/- hysterectomy
