Question 16: Prolapse

Question 1

What are the risk factors for prolapse in this patient?

Answer 1

Elderly age
Multiple NVDs (Normal Vaginal Deliveries)
Post-menopausal status
Chronic cough (due to COPD)
Obesity
Angina

Question 2

How is prolapse graded?

Answer 2

Grade 1: Prolapse halfway down the vagina
Grade 2: Prolapse to the hymenal ring
Grade 3: Prolapse beyond the hymenal ring, but not at maximum descent
Grade 4: Maximum descent (also known as procidentia)

Question 3

What additional symptoms could the patient experience depending on the type of prolapse?

Answer 3

Anterior prolapse: Bladder involvement, which could present as Lower Urinary Tract Symptoms (LUTS)
Posterior wall prolapse: Rectal involvement, causing symptoms like constipation, incomplete bowel emptying, pelvic pressure, and faecal incontinence
Sexual symptoms: Vaginal dryness, dyspareunia (painful intercourse), and coital incontinence

Question 4

What are some treatment options for prolapse?

Answer 4

Lifestyle management: Weight loss
Surgical interventions:
Anterior repair surgery (for bladder involvement)
Posterior repair surgery (for rectal involvement)
Vaginal hysterectomy and vault suspension
Sacrospinous fixation