Vaginal Prolapse

Question 1

Briefly explain what a vaginal prolapse is?

Answer 1

When the bladder, uterus or rectum protrude into the vaginal opening. Caused by weakness in muscle wall and/or nerve supply of vagina

Question 2

Risk factors?

Answer 2

Vaginal delivery
↑ Intra abdominal pressure (chronic constipation)
Previous pelvic Surgery
Hysterectomy

Question 3

Types?

Answer 3

Anterior vaginal wall prolapse:
Urethrocyle, cystocele, cystourethrocele

Posterior vag wall prolapse:
Rectocele, enterocele

Apical vag wall prolapse:
Uterovaginal, vault

Question 4

Non specific Signs and symptoms?

Answer 4

Non specific

Dragging sensation
Painful intercourse
Recurrent UTI

Question 5

What type of prolapse would these symptoms suggest?

Constipation or difficulty emptying the bowel completely

Answer 5

rectocele, enterocele, vaginal vault prolapse, or uterine prolapse

Rectocele - constipation symptoms

apical and posterior

Question 6

What type of prolapse would these symptoms suggest?

Difficulty emptying the bladder

Answer 6

cystocele, enterocele, vaginal vault prolapse, or uterine prolapse

Cystocele - urinary symptoms

Question 7

What type of prolapse would these symptoms suggest?

Enlarged vaginal opening

Answer 7

Vault

Question 8

What type of prolapse?

Pain that increases when standing for long periods of time

Answer 8

enterocele, vaginal vault prolapse, or uterine prolapse

Enterocele - standing with pain

Question 9

How does the grading system work?

Answer 9

0 - no prolapse
1 - >1cm above hymen
2 - At level of hymen
3 - >1 cm below hymen but >2cm from end of vagina
4 - Complete eversion of vagina

Question 10

Diagnosis prolapse?

Answer 10

Clinical

Question 11

Further investigations?

Answer 11

Urinary sx

Bladdar diary (urge), Urodynamic analysis (stress)

Question 12

General management options for prolapse?

Answer 12

Not necessary unless causing annoying symptoms

Conservative
Pessary
Surgery

Question 13

Conservative management of prolapse?

Answer 13

Watchful waiting
Lifestyle - treat coughs, obesity and constipation
Pelvic floor excercises - 15 reps, 3 times a day (45 in total)

Question 14

Pessary management of prolapse?

Answer 14

Ring pessary is ideal in most situations ( can have sex)

Question 15

Surgical management of prolapse?

Answer 15

Anterior colporrhaphy - bladder/urethral prolapse
30% risk return

Hysterectomy - uterine

Sacrospinous fixation - vault

Posterior colporrhaphy - rectum/bowel