Urogynaecology

Pelvic Organ Prolapse

This is due to weakness and lengthening of the ligaments and muscles around the uterus, rectum, and bladder.

• Uterine prolapse - Defect in apical vaginal wall, allowing uterus to decend into vagina

  • Vault prolapse is where the roof of the vagina descends further down (more common in those w/hysterectomy)

• Cystocele - Defect in anterior vaginal wall, allowing bladder to prolapse backwards

• Rectocele - Defect in posterior vaginal wall, allowing rectum to prolapse forwards

  • This is associated with constipation and faecal loading – This can, in turn, worsen constipation and cause urinary retention due to urethral compression

Presentation

• Feeling of something coming down into vagina

• Dragging or heavy sensation in pelvis

• Associated urinary or bowel symptoms

• Sexual dysfunction

Management

Conservative - Those coping with mild symptoms, don’t tolerate pessaries, or aren’t suitable for surgery should be advised of pelvic floor exercise, weight loss, lifestyle changes, and symptomatic relief.

Other options include:

• Vaginal pessary

  • Provides extra support to pelvic organs – Can cause significant improvement in symptoms and can be removed and replaced easily

• Surgery