Pelvic organ prolapse

Published on 09/03/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 09/03/2015

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Chapter 18 Pelvic organ prolapse

Hannah Krause

Definition. Pelvic organ prolapse is the protrusion of pelvic organs into the vaginal canal. Prolapse of pelvic organs occurs when their attachments, neural connections and supports fail.

Incidence. Pelvic organ prolapse is common and affects about 1 in 3 women who have had one or more children.

Causes and risk factors

• age, parity, vaginal delivery, connective tissue dysfunction, chronic cough, constipation, size of genital hiatus, congenital factors, obesity

History

• presenting complaint: asymptomatic or symptomatic of prolapse
• symptoms of prolapse include:

• lump
• sensation of discomfort or dragging
• voiding difficulty
• incomplete bowel emptying (splinting, manual evacuation)
• dyspareunia
• vaginal ‘wind’

• other pelvic floor history
• urinary symptoms
• sexual function: dyspareunia
• bowel function
• menstrual history: menopausal
• past medical history: may be unsuitable for surgery
• past surgical history: previous prolapse or continence surgery

Examination

• general examination, including body mass index (BMI)
• abdominal: exclude mass lesion
• vaginal

• genital hiatus: widened
• cough with and without prolapse reduced: assess for urinary leakage
• use Sims’ speculum: left lateral or lithotomy, Valsalva
• POP-Q assessment (see below)
• vaginal examination for pelvic organ assessment

POP-Q (pelvic organ prolapse quantification) classification

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