FEMALE PELVIC ORGAN PROLAPSE
ADVOCACY, EDUCATION & CARE
WHAT IS IT?
Pelvic organ prolapse occurs when the muscles and ligaments in the pelvic cavity are weakened and no longer able to support the organs contained in the pelvis. When these muscles and ligaments are weakened the uterus, bladder, or rectum prolapse into the vaginal canal. There are various types and stages of pelvic organ prolapse and prolapse can be symptomatic or asymptomatic.
WHAT PROLAPSE LOOKS LIKE
Severe Prolapse Milder Prolapse
TYPES OF PROLAPSE
Cystocele: the herniation of the bladder into the anterior vagina http://www.youtube.com/watch?v=JmEDbdzTPNM Urethrocele: herniation of the urethra in to the anterior vagina Rectocele: the extrusion of the rectum into the posterior vagina http://www.youtube.com/watch?v=Z4ieA0w7fM Enterocele: the descent of the small intestine into the vagina Uterine prolapse: the downward descent of the uterus into the vagina vault prolapse: the top of the vagina prolapses posthysterectomy.
RISK FACTORS FOR PROLAPSE
o Age o Pregnancy o Obesity o Multiple Vaginal Births o Menopause o Smoking o Previous gynecological surgery In April 2013, Dr. Don Wilson, Professor of Obstetrics and
Gynaecology at the University of Otago presented his findings from a research study he conducted (with colleagues) titled Prolong: Longitudinal Study of Pelvic Floor Dysfunction and Childbirth. The study included 1546 women.
DIAGNOSIS OF PROLAPSE
Prolapse can go undiagnosed for long periods of time due to the fact that it can be asymptomatic. Routine vaginal exam Symptoms:
vaginal bulge urinary or fecal incontinence feeling of something coming down or falling frequent UTIs related to incomplete voiding incomplete rectal evacuation.
TREATMENT OF PROLAPSE
Conservative Management: 1st Option
Lifestyle changes: weight loss, avoiding constipation, stop smoking, avoid heavy-lifting and high-impact exercise Pelvic Muscle Floor Training (PMFT): training and strengthening the muscles of the pelvis using exercised like kegels, using the expertise of urogynecologists and physical therapists.
DEVICE-BASED TREATMENT
PESSARIES
SURGICAL INTERVENTIONS FOR PROLAPSE
Many kinds of surgery can be done for pelvic organ prolapse. The type of surgery you have will depend on which organs are prolapsed. Types of surgery include: Repair of the vaginal wall (vaginal vault prolapse surgery). Repair of the bladder (cystocele surgery.) Repair of the rectum (rectocele surgery) or small bowel (enterocele surgery). Surgery to close the vagina (vaginal obliteration). This surgery is only an option if you no longer want to have sex. Removal of the uterus (hysterectomy).
Surgery is NOT an option for women who want to have more children.
Education about treatment options Education regarding PFMT/kegels Compliance with training routine and schedule-may take up to 4 months for results. Education and Teaching related to pessary use Regular removal prevents excoration, bleeding and infection Education obout post-operative care and potential complications. Education about long-term lifestyle changes that will make treatment more effective.
THE ROLE OF THE NURSE IN THE TREATMENT OF PROLAPSE Education
THE ROLE OF THE NURSE IN THE TREATMENT OF PROLAPSE Advocacy
Symptoms of prolapse can be embarrassing forcing women to avoid seeking treatment Patient may be suffering from impaired body image related to her prolapse as well as difficulty coping with the changes in her body. Sexual dysfunction and incontinence are common symptoms amongst women with pelvic organ prolapse. Patients must be treated with sensitivity and compassion. Women may be embarrassed to express an opinion about her treatment.
POTENTIAL NURSING DIAGNOSES FOR WOMEN WITH PELVIC ORGAN PROLAPSE
Body Image disturbance Situational low self-esteem Bowel Incontinence Urinary incontinence/Altered urinary elimination Urinary retention Risk for infection r/t urinary retention or surgery Impaired skin integrity r/t incontinence Sexual dysfunction/Altered sexual patterns Social Isolation
1. A 59 year old female patient with a history of hysterectomy has come to the urogynecologist with symptoms of pelvic organ prolapse. What would you expect her symptoms to be? a. Abdominal pain and cramping accompanied by bleeding from vagina b. Lower back pain, urinary incontinence, and a feeling of coming down in the pelvis c. Feelings of urgency and polyuria d. Constipation Answer: B
1. A 36 year old woman comes to the doctor and is diagnosed with pelvic organ prolapse. The patient states that she is planning on having more children. What are her options for treatment? Select all that apply. a. b. c. d. Pelvic Floor Muscle Training/Kegels Surgery Insertion of a pessary Biofeedback
Answer: A, C, D
