Pelvic Organ Prolapse
Pelvic Organ Prolapse
Pelvic Organ Prolapse
Definition
3. Perineal body, membrane and superficial/deep
POP is the herniation of pelvic organs to or beyond
muscles
the vaginal walls.
Supports distal 1/3 of vagina
Cystocoele = anterior compartment prolapse Loss contributes to rectocoele
often associated with descent of the bladder
Innervation
Management
-Coeles
Uterine prolapse
1
Surgical shortening & tightening of the perineum
Cystocoele Urethrocoele Rectocoele Enterocoele Uterine Vaginal
What is the Bladder Urethra Rectum Small bowel/pouch of Uterus Apex of vagina
prolapsing Douglas
part?
Where does it Upper 2/3 of anterior Lower 1/3 of the Lower posterior vaginal Upper posterior vaginal 1st degree to the upper 2nd degree to the
extend to? vaginal wall anterior vaginal wall wall wall vagina introitus
2nd degree to the
introitus 3rd degree
3rd degree cervix is external to the
outside the introitus introitus
4th degree (uterine
procidentia) herniation
of all 3 compartments
(uterus and cervix)
outside the introitus
Risk factors Vaginal childbirth Concomitant Vaginal childbirth Childbirth Pregnancy (especially 2 to hysterectomy
Chronic constipation presence of a Use of forceps during Ageing multiple births) (All the other stuff)
Violent coughing cystocoele delivery Vaginal childbirth
Heavy lifting Childbirth Prolonged labour Urinary incontinence
Congenital pelvic Congenital pelvic Previous vaginal tear (obstruction overflow)
floor weakness floor weakness (esp. if 3rd degree) Obesity
Chronic intra-abdominal
constipation/straining pressure (e.g. coughing,
constipation)
Fibroids
Signs & Sense of fullness in Recurrent UTI Sensation of rectal Pulling sensation in 1st degree: If 3rd degree, maybe
symptoms the vagina Thin, reddish fullness the pelvis Minimal dried, thickened
Urinary membrane Incomplete emptying Feeling of pelvic 2nd degree: vaginal mucosa
incontinence protruding from one Constipation fullness/pain Pulling sensation in Ulcerations may
Incomplete portion of the Lower abdo pain Palpable bulge in the pelvis resemble vaginal
emptying urethral opening Lower back pain the vagina Feeling of pelvic cancer (pain +
Recurrent UTI Urinary Faecal incontinence Dyspareunia fullness/pain bleed)
frequency/urgency Palpable bulge in the Signs of
Dysuria vagina thrush/infection
Dyspareunia Dyspareunia Presence of
3rd degree cystocoele/
Bulge or protrusion of rectocoele
the cervix or vaginal
cuff +/- spontaneous
reduction
+/- ulcerations
Diagnosis Pelvic examination Pelvic examination Pelvic examination Pelvic examination Pelvic examination Pelvic examination
Single-bladed Single-bladed
speculum against Voiding speculum against
posterior vaginal cystourethrograms anterior vaginal wall
wall (VCUG) Asking patients to
Asking patients to strain makes the
strain makes the IV pyelogram prolapse
prolapse visible/palpable
visible/palpable Urodynamic testing
Proctogram/
Urine post-void residual defaecagram
volume (PVR)
>100mL = urine
retention
Management 1. Vaginal pessary + 1. Lifestyle (weight 1. Lifestyle (high fibre 1. Observation 1. Asymptomatic 1st or 2nd degree
pelvic floor physio loss, exercise) + diet, fibre No treatment required
pelvic floor physio supplements, stay 2. Pessary + pelvic floor Kegel exercises
2. Surgical repair of hydrated) physio
supporting 2. Symptomatic 1st or 2nd degree
structures (anterior 2. Conservative (stool 3. Surgery Pessary
& posterior softeners) Surgery (2nd line)
colporrhaphy +/- i. Hysterectomy with colporrhaphy +
perineorrhaphy2) 3. Pelvic floor exercises suspension of the top of the vagina
ii. Vaginal sacrospinous ligament
4. Insertion of pessary suspension/
iii. colpopexy
iv. Abdominal sacrocolpopexy
2
Surgical shortening & tightening of the perineum