W1 - Pelvic Organ Prolapse Flashcards
who gets a prolapse
older age
multiple children
rare in people who’ve never had kids
what is the parity aetiology of a prolapse
Damage to muscular and fascial supports of pelvic floor
what is the anatomy of the pelvic flood which makes it likely to have a prolapse
Axis of levator ani muscles more oblique-creating a funnel through which the uterus, vagina and rectum can fall
how does a reduction in oestrogen increase the risk of a prolapse
causes reduction in strength of pelvic connective tissue- less collagen, less elastic
how does smoking increase the risk of prolapse
Causes chronic cough leads to increase in intra-abdominal pressure and greater strain on pelvic floor - exacerbates defects in the pelvic floor
how does constipation increase the risk of prolapse
Causes chronically increased intra- abdominal pressure due to repetitive straining - exacerbates weaknesses in the pelvic floor
how does heavy lifting increase the risk of prolapse
Increased stress on the pelvic floor exacerbates defects
Farming identified as associated with prolapse
how does surgery increase the risk of prolapse
causes defects in other compartments- usually posterior compartment
what is a urethrocoele prolapse
prolapse of lower anterior vaginal wall involving urethra only
what is a cystocoele prolapse
prolapse of upper anterior vaginal wall involving bladder (usually urethra too: cystourethrocoele)
what is a uterovaginal prolapse
prolapse of uterus, cervix and upper vagina
what is a enterocoele prolapse
prolapse of upper posterior vaginal wall- containing loops of ileum
what is a retrocoele prolapse
prolapse of lower posterior wall of the vagina involving anterior wall of rectum
what is a first degree urogenital prolapse
Lowest part of prolapse halfway down vaginal axis at introitus
what is a second degree urogenital prolapse
Lowest part extends to introitus, through introitus on straining
what is a third degree urogenital prolapse
lowest part extends through introitus and outside vagina.
what scoring scale is for prolapse
POPQ
what muscles are part of the pelvic floor
Levator ani, urogenital diaphragm, endopelvic fascia and perineal body
what passes through the urogenital hiatus
urethra, vagina and rectum
what are the 3 divisions of the levator ani
pubococcygeus, illeococcygeus and puborectalis
what are the 2 muscles of the pelvic floor
Levator ani and coccygeus-
where is the perineal body
between the vagina and rectum
what are common symptoms of a prolapse
Dyspareunia
Chronic lower back ache
Mucosal ulceration
what may a cystocoele present with
urinary frequency
urgency
incomplete emptying
UTI
