Prolapse of the uterus and vagina

Question 1

List the types of prolapse

Answer 1

Urethrocoele
Cystocoele
Apical prolapse
Enterocoele
Rectocoele

Question 2

What is a urethrocele?

Answer 2

Prolapse of the lower anterior vaginal wall, involving the urethra only

Question 3

What is a cystocoele?

Answer 3

Prolapse of the upper anterior vaginal wall, involving the bladder.

Question 4

What is an apical prolapse?

Answer 4

Prolapse of the uterus, cervix and upper vagina.

Question 5

What is an enterocoele prolapse?

Answer 5

Prolapse of the upper posterior wall of the vagina. The resulting pouch usually contains loops of small bowel.

Question 6

What is a rectocoele prolapse?

Answer 6

Prolapse of the lower posterior wall of the vagina, involving the anterior wall of the rectum.

Question 7

How do you grade/classify a prolapse?

Answer 7

Baden-Walker classification:
0 = no descent of pelvic organs during straining
1 = Leading surface of prolapse does not descend below 1cm above the hymenal ring
2 = Leading edge of the prolapse extends from 1cm above to 1cm below the hymenal ring
3 = Prolapse extends 1 cm or more below the hymenal ring but without complete vaginal eversion.
4 = vagina completely everted (complete procidentia)

Question 8

What are the causes of prolapse?

Answer 8

Vaginal delivery and pregnancy
Congenital collagen deficiency
Menopause
Chronic elevated abdominal pressure
Pelvic surgery

Question 9

What are some symptoms of a prolapse?

Answer 9

Symptoms are often absent
Dragging sensation/feeling of a lump
Worse at the end of a day/after standing
Severe prolapse interferes with intercourse, may ulcerate and cause bleeding or discharge. 
Urinary frequency (cystocoele) 
Difficulty in defaecating (rectocoele)

Question 10

What worsens prolapse?

Answer 10

Menopause - loss of elastic tissue from lack of oestrogen.
Smoking
Obesity

Question 11

What treatment can be used for prolapse if surgery is not possible?

Answer 11

Pessaries - ring pessary is most commonly used, but the shelf pessary is more effective for severe forms of prolapse.

Question 12

Where to pessaries go?

Answer 12

Behind the pubic symphysis and in front of the sacrum

Question 13

How often are pessaries changed?

Answer 13

Every 6 to 9 months

Question 14

What is important to give postmenopausal women with a pessary?

Answer 14

Oestrogen to prevent vaginal ulceration.

Question 15

What is the treatment in women with severe prolapse?

Answer 15

Surgery