Flashcards in Genitourinary Prolapse Deck (82)
How do mild pelvic organ prolapses present?
Many are asymptomatic and are incidental findings
How severe can the symptoms of pelvic organ prolapse be?
Severe enough to affect quality of life
What are the symptoms of pelvic organ prolapse related to?
Site and type of prolapse
What are the vaginal/general symptoms of pelvic organ prolapse?
- Sensation of pressure/fullness/heaviness
- Sensation of bulge or 'something coming down'
- Seeing/feeling a bulge/protrusion
- Difficulty retaining tampons
What can cause spotting in a pelvic organ prolapse?
Ulceration of the prolapse
What are the potential urinary symptoms of pelvic organ prolapse?
- Feeling of incomplete bladder emptying
- Weak or prolonged urinary stream
- Need to reduce prolapse manually before voiding
- Need to change position to start voiding
What are the symptoms of coital difficulty that may present in pelvic organ prolapse?
- Loss of vaginal sensation
- Vaginal flatus
- Loss of arousal
What are the potential bowel symptoms in pelvic organ prolapse?
- Urgency of stool
- Incontinence of flatus or stool
- Incomplete evacuation
- Need to apply digital pressure to perineum or posterior vaginal wall to enable defecation
- Digital evacuation necessary
In what positions should patients presenting with pelvic organ prolapse be examined?
- Left lateral position
What should the patient be asked to do whilst examining for prolapse?
How should the vagina be examined when assessing pelvic organ prolapse?
With a speculum
What may be noticed on pelvic organ prolapse examination?
When are abnormalities of the mucosa likely to occur in pelvic organ prolapse?
When the prolapse protrudes beyond the hymen level
How is pelvic organ prolapse usually diagnosed?
Based on history and examination
What tests should be considered if urinary symptoms are present in pelvic organ prolapse?
- Post-void residual urine volume testing using catheter or bladder USS
- Urodynamic investigations
- Urea and creatinine
- Renal USS
What tests can be considered if bowel symptoms are present in pelvic organ prolapse?
- Anal manometry
- Endo-anal USS
When is treatment of a prolapse not necessary?
In mild and/or asymptomatic prolapse
What are the broad management options for pelvic organ prolapse?
- Vaginal pessary
Who is conservative management of pelvic organ prolapse particularly helpful for?
- Mild prolapse
- Want further pregnancies
- Frail or elderly
- High anaesthetic risk
- Don't want surgery
What are the approaches to conservative management of pelvic organ prolapse?
- Watchful waiting
- Lifestyle modification
- Pelvic floor muscle exercises
- Vaginal oestrogen creams
When may further treatment be required for pelvic organ prolapse following watchful waiting?
If symptoms become troublesome or complications develop
What lifestyle modifications can conservatively treat pelvic organ prolapse?
- Weight loss
- Minimising heavy lifting
- Preventing or treating constipation
Who can vaginal oestrogen creams be useful for treating pelvic organ prolapse in?
Women with signs of vaginal atrophy
What is the function of a vaginal pessary in pelvic organ prolapse?
It is inserted in the vagina to reduce the prolapse and provide support and relieve pressure on the bladder and bowel
What can vaginal pessaries be used in combination with to treat pelvic organ prolapse?
Pelvic floor muscle exercises
How long can vaginal pessaries for prolapse be used for?
- Short-term prior to surgery
- Long-term if surgery is not an option
What should patients wanting vaginal pessary for prolapse be made aware of?
- More than one fitting may be necessary
- May affect sexual intercourse
- Should be changed every 6 months
What are the potential complications of a vaginal pessary for pelvic organ prolapse?
- Difficulty removing pessary
- Vesicovaginal and rectovaginal fistulas
- Faecal impaction
What are the indications for surgical intervention for pelvic organ prolapse?
- Failure of conservative management
- Presence of voiding problems or obstructed defecation
- Recurrence of prolapse
- Irreducible prolapse
- Woman prefers surgery