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GENITAL ORGAN PROLAPSE (CLASSIFICATION (UTERUS AND CERVIX (cervix occupies…
GENITAL ORGAN PROLAPSE
Uterovaginal prolapse is described as the descent of one or more pelvic organs (urethra, bladder, uterus, pouch of douglas) into the vagina
AETIOLOGY
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can aggravate the condition: OBESITY, CHRONIC COUGH AND CONSTIPATION = all raise intra-abdo pressure
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CLASSIFICATION
Original position = anterior. prolapse = cystocele. symptoms = poor bladder emptying, residual urine, frequency and urinary infection
Original position = central. prolapse = cervix/uterus (1st 2nd & 3rd degree and procidentia) and vaginal vault. symptoms = bleeding and/or discharge from ulceration in assoc with procidentia, Backache
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Original position = posterior. prolapse = enterocele (POD) Rectocele. symptoms = pressure, backache; Difficulty in bowel emptying
URETHROCELE
descent of the part of the ant vag wall which is fused to the urethra
approximately the first 3-4cm of the anterior wall superior to the urethral meatus
any descent of this tissue may alter the urethrovesical angle and disrupt the continence mechanism, predisposing to SUI
CYSTOCELE
The bladder base lies immediately above this. descent of this area is termed cystocele. Urethroceles and cystoceles may prolapse together, and when both are present the term cystourethrocele is used
UTERUS AND CERVIX
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procidentia is a term used when the cervix, uterus and vaginal wall have completely prolapsed through the introitus. Exposure of the cervix and vagina outside the introitus may lead to ulceration of the cervix and thickening of the vaginal mucosa.
RECTOCELE
weakening of the tissue that lies between the vagina and rectum (rectovaginal fascia) allows the rectum to protrude into the lower posterior vaginal wall, causing a rectocele.
laxity of the perineum may also be present which gives a gaping appearance to the fourchette (the posterior margin of the introitus)
ENTEROCELE
truly is a hernia. it has a sac, neck and contents. the sac is a protrusion of the peritoneum of the POD and may contain small bowel or omentum
SYMPTOMS
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back ache characteristically improves when lying down, can be caused by prolapse (most typically uterus, vault or enterocele), pain is not
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MANAGEMENT
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CONSERVATIVE
advise about weight reduction, smoking cessation and normalisation of fluid intake
supervised pelvic floor PT (reduces mild to mod prolapse) - not effective when prolapse is well established
pessaries commonly used - supports the uterus and may also help reduce cystocele but not a rectocele - change every 4-6mths
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complications = urinary frequency/infection, vag discharge, bleeding, rarely a fistula forms
SURGERY
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uterine descent - vaginal hysterectomy or manchester repair [but first consider if it is being pushed down by a mass eg ovarian cancer with gross ascites]
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