Vaginal Prolapse Flashcards Preview

Michael O&G - Connecting the dots > Vaginal Prolapse > Flashcards

Flashcards in Vaginal Prolapse Deck (15)
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1
Q

Briefly explain what a vaginal prolapse is?

A

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

2
Q

Risk factors?

A

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

3
Q

Types?

A

Anterior vaginal wall prolapse:
Urethrocyle, cystocele, cystourethrocele

Posterior vag wall prolapse:
Rectocele, enterocele

Apical vag wall prolapse:
Uterovaginal, vault

4
Q

Non specific Signs and symptoms?

A

Non specific

Dragging sensation
Painful intercourse
Recurrent UTI

5
Q

What type of prolapse would these symptoms suggest?

Constipation or difficulty emptying the bowel completely

A

rectocele, enterocele, vaginal vault prolapse, or uterine prolapse

Rectocele - constipation symptoms

apical and posterior

6
Q

What type of prolapse would these symptoms suggest?

Difficulty emptying the bladder

A

cystocele, enterocele, vaginal vault prolapse, or uterine prolapse

Cystocele - urinary symptoms

7
Q

What type of prolapse would these symptoms suggest?

Enlarged vaginal opening

A

Vault

8
Q

What type of prolapse?

Pain that increases when standing for long periods of time

A

enterocele, vaginal vault prolapse, or uterine prolapse

Enterocele - standing with pain

9
Q

How does the grading system work?

A
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
10
Q

Diagnosis prolapse?

A

Clinical

11
Q

Further investigations?

A

Urinary sx

Bladdar diary (urge), Urodynamic analysis (stress)

12
Q

General management options for prolapse?

A

Not necessary unless causing annoying symptoms

Conservative
Pessary
Surgery

13
Q

Conservative management of prolapse?

A

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

14
Q

Pessary management of prolapse?

A

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

15
Q

Surgical management of prolapse?

A

Anterior colporrhaphy - bladder/urethral prolapse
30% risk return

Hysterectomy - uterine

Sacrospinous fixation - vault

Posterior colporrhaphy - rectum/bowel