10 Questions
What is the most common type of anterior vaginal wall prolapse?
Cystocele
What is the medical term for the bulging of the urethra in the lower 1/4 of the anterior vaginal wall?
Urethrocele
What is the term for the total or complete anterior vaginal wall prolapse?
Cysto-urethrocele
What is the type of posterior vaginal wall prolapse that involves the bulging of the small intestine into the vagina?
Enterocele
What is the type of posterior vaginal wall prolapse that involves the bulging of the rectum into the vagina?
Rectocele
What is the type of prolapse that occurs when the vaginal vault (the upper part of the vagina) falls into the vaginal canal?
Vaginal Vault Prolapse
What is the congenital factor that may contribute to the development of prolapse?
Congenital shortness of the vagina
What is the racial factor that may contribute to the lower prevalence of prolapse?
Better connective tissue with greater collagen in ligaments
What is the precipitating factor that may reveal prolapse when the supports are already weakened?
Raised intra-abdominal pressure
What is the type of prolapse that occurs when the uterus falls into the vaginal canal?
Uterine Prolapse
Study Notes
Types of Prolapse
- Posterior vaginal wall prolapse can be divided into two types: Enterocele and Rectocele
- Enterocele is the descent of the upper part of the posterior vaginal wall, lined by peritoneum of Douglas pouch, containing intestine
- Rectocele is the descent of the lower part of the posterior vaginal wall, usually occurring with perineal tears
Vaginal Vault Prolapse
- This type of prolapse occurs when the vault of the vagina is displaced downward, usually after hysterectomy
- Increased intra-abdominal pressure directed against the top of an inadequately supported vagina can cause vaginal vault prolapse
- Etiology: usually following hysterectomy, more common in subtotal hysterectomy, and neglected enterocele
- Lack of surgical prophylaxis can also contribute to vaginal vault prolapse
Uterine Prolapse
- Uterine prolapse can be classified into four degrees:
- First degree: The cervix is within the vagina above the level of the introitus but below the level of the ischial spine
- Second degree: The cervix is out of the vagina, but the body of the uterus is inside
- Third degree & Fourth degree: A variable extent of the body of the uterus is out of the vagina, either partially or complete (procidentia)
Clinical Picture
- Symptoms and examination are crucial in diagnosing prolapse
- Local examination (pelvic examination) involves two separate evaluations: first with the patient at rest, and then under conditions of maximal straining (Valsalva maneuver)
Predisposing Factors
- Menopausal factors: estrogen deficiency leads to decreased vascularity and degeneration of ligaments
- Congenital factors: congenital bony lesions, collagen disease, anatomical anomalies, and congenital weakness of connective tissues
- Race: black women may have a lower prevalence of prolapse due to better connective tissue with greater collagen in ligaments, or lumbar lordosis
Precipitating Factors
- Raised intra-abdominal pressure: chronic obstructive airways disease, smoking, straining at stools with constipation, heavy physical work, and abdominal mass or ascites
- Factors causing traction on the uterus: cervical polyp, fibroid
This quiz covers the types of vaginal prolapse, including enterocele, rectocele, and vaginal vault prolapse, as well as their symptoms and causes.
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