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34.pelvic Organ Prolapse

Pelvic organ prolapse is the descent of the uterus and/or vaginal wall due to weakened supporting structures, classified into three degrees of severity. Associated conditions include cystocele, urethrocele, enterocele, rectocele, and vaginal vault prolapse, often caused by factors such as childbirth, aging, and obesity. Treatment options range from Kegel exercises and pessaries to hormone replacement therapy and surgical interventions.

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Joseph Agbenyega
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10 views10 pages

34.pelvic Organ Prolapse

Pelvic organ prolapse is the descent of the uterus and/or vaginal wall due to weakened supporting structures, classified into three degrees of severity. Associated conditions include cystocele, urethrocele, enterocele, rectocele, and vaginal vault prolapse, often caused by factors such as childbirth, aging, and obesity. Treatment options range from Kegel exercises and pessaries to hormone replacement therapy and surgical interventions.

Uploaded by

Joseph Agbenyega
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Pelvic organ prolapse

DR. ISAAC O. KORANTENG


Bsc. MB.,ChB.,FWACS
Pelvic organ prolapse
Refers to the descent of the uterus and or the
vaginal wall through the introitus due to the
weakness in their supporting structures.

The main support of the uterus are


• The Cardinal/ transverse cervical/ Mackenrodt
ligament
• Uterosacral ligament
stages
First degree: The cervix droops into the vagina but still remains
within the vagina

Second degree: The cervix is outside the vagina and appears


on the vulva

Third degree: The entire uterus is outside the vagina. This


condition is also called procidentia.

Other conditions are usually associated with prolapsed uterus.


They weaken the muscles that hold the uterus in place:
Anterior wall defects
• Cystocele: Bulging of the upper vaginal wall
where a part of the bladder bulges into the
vagina. This may lead to urinary frequency,
urgency, retention, and incontinence

• Urethrocele: bulging of the urethra into


vagina
Posterior wall defects
• Enterocele: The bulging of the upper posterior vaginal wall
with herniation of bowel into the pouch so formed. (True
hernia). Standing leads to a pulling sensation and backache
that is relieved when you lie down.

• Rectocele: The bulging of the lower posterior vaginal wall


where the rectum bulges into the vagina. This makes bowel
movements difficult, to the point that you may need to push
on the inside of your vagina to empty your bowel

• Vaginal vault prolapse; Prolapse of the vaginal vault after


hysterectomy
Causes
• Pregnancy/multiple childbirths
• Complicated delivery - Vacuum extraction or Forceps delivery
• Weakness in the pelvic muscles with advancing age
(Menopause)
• Weakening and loss of tissue tone after menopause and loss of
natural estrogen
Overweight or obesity
Major pelvic surgery
• Excess weight lifting
• Being Caucasian
• Increased intra-abdominal pressure - chronic cough, straining
(with constipation), pelvic tumors, Ascites
Clinical Features
• Sensation of something moving down in the
vagina
• Urinary symptoms – retention, frequency
• Bowel symptoms - constipation
• Low back ache
• Cervical ulceration
Treatment
• Expectant – Kegel excercise
• Pessary
• Hormone replacement Therapy
• Surgery – Vaginal Hysterectomy plus Pelvic
flow repair
Pelvic flow repair
• Anterior colporrhaphy - Cystocele
• Posterior colpoperineorrhaphy - Enterocele +
Rectocele

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