Genital Prolapse Overview
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Questions and Answers

What is the defining characteristic of 1st degree uterine prolapse?

The cervix descends below its normal level on straining but does not protrude from the vulva.

Identify one primary cause of uterine prolapse.

Weakness of the supporting structures of the uterus and vagina due to childbirth trauma.

What symptom might a patient experience before the visible signs of prolapse occur?

A sensation of weakness in the perineum, especially towards the end of the day.

What are two common urinary symptoms associated with uterine prolapse?

<p>Urgency and frequency of urination, and stress incontinence.</p> Signup and view all the answers

Describe the main feature of 3rd degree uterine prolapse.

<p>The entire uterus is completely prolapsed outside the vulva, leading to vaginal wall inversion.</p> Signup and view all the answers

What is genital prolapse and which organs can be involved?

<p>Genital prolapse is the descent of one or more genital organs, including the urethra, bladder, uterus, rectum, or Douglas pouch, below their normal level.</p> Signup and view all the answers

Define the terms version and flexion in relation to the uterus.

<p>Version is the angle between the longitudinal axis of the cervix and that of the vagina, while flexion is the angle between the longitudinal axis of the uterus and that of the cervix.</p> Signup and view all the answers

What is the classification of anterior vaginal wall prolapse?

<p>Anterior vaginal wall prolapse is classified as cystocele (upper part), urethrocele (lower part), and cysto-urethrocele (complete anterior wall prolapse).</p> Signup and view all the answers

How is rectocele different from enterocele in posterior vaginal wall prolapse?

<p>Rectocele involves the anterior wall of the rectum prolapsing with the posterior vaginal wall, while enterocele refers to a hernia of the pouch of Douglas in the upper third of the posterior vaginal wall.</p> Signup and view all the answers

What characterizes vault prolapse and which surgical history is it linked to?

<p>Vault prolapse is characterized by the descent of the vaginal vault and is more likely to occur after subtotal hysterectomy.</p> Signup and view all the answers

Distinguish between utero-vaginal and vagino-uterine prolapse.

<p>Utero-vaginal prolapse occurs when the uterus descends first, followed by the vagina, while vagino-uterine prolapse occurs when the vagina descends first, followed by the uterus.</p> Signup and view all the answers

What are common predisposing factors for genital prolapse?

<p>Common predisposing factors include childbirth, congenital weakness of pelvic support structures, and surgeries such as hysterectomy.</p> Signup and view all the answers

How can the assessment of genital-uterine prolapse be conducted?

<p>Assessment of genital-uterine prolapse can be conducted through physical examination, patient history, and specific diagnostic tests.</p> Signup and view all the answers

What is the primary purpose of a pessary in the treatment of prolapse?

<p>A pessary supports the uterus and prevents its descent by stretching the redundant vaginal wall.</p> Signup and view all the answers

What are some contraindications for surgical repairs of prolapse?

<p>Contraindications include lactation, severe cough, or patients who refuse surgical intervention.</p> Signup and view all the answers

Why might a cup and stem pessary be used instead of a ring pessary?

<p>A cup and stem pessary is used when the pelvic floor is too weak or lacerated to retain a ring pessary.</p> Signup and view all the answers

What are the recommended cleaning practices for a pessary?

<p>Patients should have a daily vaginal douche and the pessary should be removed, cleaned, and reintroduced monthly.</p> Signup and view all the answers

What procedure is typically performed for a 3rd degree prolapse?

<p>A Vaginal Hysterectomy is performed for a 3rd degree prolapse.</p> Signup and view all the answers

What condition is associated with congestion and can lead to leucorrhoea?

<p>Pelvic organ prolapse.</p> Signup and view all the answers

Describe the characteristics of a Stage II prolapse according to the POP-Q scoring system.

<p>The leading edge of the prolapse extends from 1 cm above to 1 cm below the hymenal ring.</p> Signup and view all the answers

What are two key preventive measures during antenatal care to avoid pelvic organ prolapse?

<p>Ensure the pelvic floor is strong and elastic, and prevent constipation.</p> Signup and view all the answers

What should be avoided during delivery to help prevent pelvic organ prolapse?

<p>Avoid straining before full cervical dilatation and applying forceps prematurely.</p> Signup and view all the answers

List two physiotherapeutic aims in the treatment of pelvic organ prolapse.

<p>To establish awareness of pubococcygeus function and to strengthen the pubococcygeus muscle.</p> Signup and view all the answers

Under what conditions might a ring pessary be indicated as a treatment option?

<p>In slight degrees of prolapse in young patients and prolapse of the uterus during early pregnancy.</p> Signup and view all the answers

What is the importance of post-natal care in the context of pelvic organ prolapse?

<p>Accurate repair of perineal tears and prevention of constipation are crucial.</p> Signup and view all the answers

What is the goal of pelvic floor exercises after childbirth?

<p>To encourage strengthening of the pelvic floor muscles to support the pelvic organs.</p> Signup and view all the answers

Study Notes

Genital Prolapse

  • Genital prolapse is the descent of one or more genital organs, including the urethra, bladder, uterus, rectum, or Douglas pouch, through the fasciomuscular pelvic floor.
  • The uterus is normally anteverted and anteflexed.
  • Vaginal prolapse can occur without uterine prolapse, but the uterus cannot descend without carrying the vagina with it.

Types of Prolapse

  • Vaginal Prolapse:
    • Anterior vaginal wall prolapse:
      • Prolapse of the upper part of the anterior vaginal wall with the base of the bladder is called cystocele.
      • Prolapse of the lower part of the anterior vaginal wall with the urethra is called urethrocele.
      • Complete anterior vaginal wall prolapse is called cysto-urethrocele.
    • Posterior vaginal wall prolapse:
      • Rectocele: The anterior wall of the rectum prolapses with the middle third of the posterior vaginal wall.
      • Entrocele: The upper third of the posterior vaginal wall descends lined by the peritoneum of the Douglas pouch.
    • Vault prolapse: Descent of the top of the vagina after hysterectomy. Vault prolapse is more common after subtotal hysterectomy.
  • Uterine Prolapse:
    • Utero-vaginal prolapse: The uterus descends first, followed by the vagina. Typically occurs in virgins and nulliparous women due to congenital ligament weakness.
    • Vagino-uterine prolapse: The vagina descends first, followed by the uterus. Usually occurs due to obstetric trauma.

Degrees of Uterine Prolapse

  • 1st degree: The cervix descends below its normal level on straining but does not protrude from the vulva.
  • 2nd degree: The cervix protrudes from the vulva on straining or at the level of the introitus.
  • 3rd degree (Complete procidentia): The entire uterus is prolapsed outside the vulva, and the vaginal wall completely inverts over it. Enterocele is usually present, and a decubitus ulcer can develop due to friction and reduced blood supply.

Etiology of Prolapse

  • The primary cause of prolapse is weakness of the supporting structures of the uterus and vagina, often due to childbirth trauma.
  • These structures include the uterosacral ligament and cervical ligament.

Predisposing Factors

  • Weakness of pelvic cellular tissue:
    • Obstetric trauma
    • Congenital weakness
    • Postmenopausal atrophy
  • Injury to the pelvic floor.

Symptoms of Prolapse

  • Feeling of weakness in the perineum, particularly at the end of the day.
  • A mass appearing on straining and disappearing when lying down.
  • Urinary symptoms: urgency, frequency, stress incontinence, difficulty urinating without manual assistance, and cystitis.
  • Rectal symptoms: heaviness in the rectum, constant urge to defecate, and piles due to straining.
  • Backache, congestive dysmenorrhea, menorrhagia, and leucorrhoea.

Pelvic Organ Prolapse Quantitative (POP-Q) Scoring

  • Stage 0: No descent of pelvic organs.
  • Stage I: Leading edge of the prolapse does not descend below 1 cm above the hymenal ring.
  • Stage II: Leading edge of the prolapse extends from 1 cm above to 1 cm below the hymenal ring.
  • Stage III: Leading edge of the prolapse extends from 1 cm below the hymenal ring, but without complete vaginal eversion.
  • Stage IV: Essentially complete vaginal eversion.

Treatment of Prolapse

  • Prophylactic (Preventing) Treatment for Obstetric Prolapse:

    • Proper prenatal care: Strengthening and maintaining pelvic floor elasticity. Prevention of constipation.
    • Proper intranatal care: Avoiding factors that contribute to prolapse, such as straining during the first stage of labor, forceps application before full cervical dilatation, and fundal pressure to deliver the placenta.
    • Proper postnatal care: Accurate repair of perineal tears, postural treatment, correction of retroversion, pelvic floor exercises, prevention of puerperal constipation, and maintaining general health.

  • Palliative (Symptomatic) Treatment:

    • Physiotherapy: Indicated in early and mild cases, prophylactically after delivery, and for symptom relief in more severe cases. Aims to increase awareness of pelvic support function and strengthen the pubococcygeus muscle.
    • Pessaries: Indicated for slight degrees of prolapse in young patients, prolapse during early pregnancy, contraindications to surgery, and high surgical risk patients.

  • Surgical Treatment:

    • Posterior colporrhaphy: Repair of the posterior vaginal wall.
    • Anterior & Posterior colporrhaphy: Repair of both the anterior and posterior vaginal walls.
    • Manchester operation: For 2nd degree prolapse.
    • Vaginal hysterectomy: For 3rd degree prolapse (procidentia).

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Related Documents

Genital Prolapse: Displacements Of The Uterus PDF

Description

This quiz explores the anatomy and types of genital prolapse, including details about vaginal prolapse and its classifications. Understand the different forms such as cystocele, urethrocele, and rectocele, and their implications for pelvic floor health. Test your knowledge on this important topic in gynecology.

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