Uterovaginal prolapse Flashcards
What are risk factors for prolapse?
Post-menopausal
Vaginal delivery - higher parity, larger baby, episiotomy repair
Post-operative - hysterectomy
Congenital - collagen
Raised intra-abdominal pressure - chronic cough, obesity, constipation, heavy lifting, pregnancy
What are symptoms of severe prolapse?
Renal failure (ureteric kinking)
Urinary retention– bleeding/ulceration
Infection
What is uterovaginal prolapse?
falling, slipping or downward displacement of the uterus and/or the different vaginal compartments and their neighbouring organs such as bladder, rectum or bowel
What are symptoms of cystocele (bladder)?
Stress incontinence - voiding difficulties
Urinary frequency
Obstructive symptoms – Recurrent urine infections
Urgency/frequency
What are symptoms of rectocele?
Incomplete bowel emptying
Difficulty wiping clean/Soiling/incontinence
What are symptoms of general prolapse?
Dragging sensation (discomfort, pain) – Feeling a lump in the vagina
Dyspareunia
What is the management of prolapse?
Pessary - inserted into vagina to support the uterus
Topical atrophy for vaginal atrophy
What are complications of pessaries?
Vaginal discharge
Bleeding
Difficulty removing pessary
Pessary expulsion
What is the abdominal approach of prolapse?
use of mesh - operation (consider age, BMI, previous operations)
What are the types of anterior vaginal wall prolapse?
urethrocele, cystocele
What are the types of apical vaginal prolapse?
Uterus + inversion of upper vagina – uterovaginal
Vaginal apex (post hysterectomy) - vault
