Term
| Define pelvic organ prolapse. |
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Definition
| herniation of pelvic organs to or beyond the vaginal walls |
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Term
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Definition
| herniation of the upper front vaginal wall, bladder protrudes into the vagina |
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Term
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Definition
| descent of the uterus below its normal position |
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Term
| What two major components support the pelvic organs? |
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Definition
- levator ani muscle complex
- endopelvic fascia
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Term
| How does the levator ani muscle complex work to support the pelvic organs? |
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Definition
| provides a firm, elastic base where pelvic organs rest |
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Term
| How does the endopelvic fascia work to support the pelvic organs? |
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Definition
| stabilizes the pelvic organs in the correct position, which allows the muscles to provide optimal support |
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Term
| How does a prolapse occur? |
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Definition
| muscular and fascial tissue lose tone and strength, which leads to failure of these complexes to maintain organs in their correct position, and results in organ descent |
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Term
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Definition
| Yes, 25% to 65% of women have evidence of a prolapse. |
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Term
T or F
All women with a prolapse are symptomatic. |
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Definition
| False. Many women are asymptomatic and the prolapse is identified upon clinical exam. |
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Term
Who has a higher incidence of prolapse:
parous or non-parous women? |
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Definition
| Parous women. 75% of prolapse occurs among parous women. |
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Term
T of F
Advanced age is a risk factor for prolapse. |
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Definition
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Term
T of F
BMI is unrelated to prolapse risk. |
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Definition
| False. BMI>25 results in a 2 fold higher risk. |
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Term
| List other situations that increase a woman's risk of prolapse. |
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Definition
- Pelvic surgery
- Connective tissue disorder
- Heavy lifting
- Chronic constipation
- Coughing
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Term
| Women commonly report feeling pressure when they present for clinical exam. How will they typically verbalize this sensation? |
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Definition
| "something is falling out" |
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Term
| What are common symptoms of uterine prolapse? |
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Definition
- pressure-vaginal bulge, something falling out
- sexual-dyspareunia, embarrassment
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Term
| What are common symptoms of a cystocele? |
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Definition
- pressure- vaginal bulge, heaviness
- urinary-stress urinary incontinence, urethral obstruction, splinting during urination, slow stream
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Term
| In addition to obtaining a thorough medical/surgical/OB/GYN history, how will prolapse be diagnosed? |
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Definition
| Speculum and bimanual exam performed in the standing and dorsal lithotomy position. |
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Term
| When assessing a women for prolapse, while performing the exam it is necessary to instruct her to do what? |
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Definition
| Valsalva is necessary in order to observe the full extent of the prolapse. |
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Term
T or F
Obtain a clean catch urine when evaluating for prolapse. |
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Definition
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Term
| It is necessary to document prolapse using a classification system. How many degrees of prolapse are typically used? (Reference is Secor) |
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Definition
| Four degress-1st, 2nd, 3rd, 4th |
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Term
| Define 1st degree prolapse. |
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Definition
| prolapse without symptoms, mild organ descent |
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Term
| Prolapse with descent halfway into the vagina and usually asymptomatic is which degree of prolapse? |
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Definition
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Term
| Define 3rd degree prolapse. |
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Definition
| Prolapse is at the level of the introitus, usually symptomatic. |
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Term
| What degree of prolapse is characteristic of prolapse outside the vagina with severe symptoms? |
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Definition
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Term
| Uterine prolapse and cystocele both have non-surgical options for treatment. List them. |
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Definition
- Expectant-no intervention necessary if asymptomatic
- Kegels
- Vaginal pessary
- ERT
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Term
| What are the surgical options for treatment of uterine prolapse? |
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Definition
- hysterectomy
- uterine suspension
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Term
| What are the surgical options for treatment of cystocele? |
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Definition
- bladder suspension/sling
- periurethral bulking (treats stress incontinence)
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Term
| What are the benefits of a vaginal pessary? |
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Definition
- supports prolapsed organs
- women can independently care for them
- some can be worn during intercourse
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Term
| On average, how often do women need to be evaluated while undergoing treatment with a vaginal pessary? |
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Definition
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Term
T or F
Women should be counseled that pessaries are going to be uncomfortable during the entire course of treatment. |
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Definition
| False. Once properly fitted, the pessary should not be felt. |
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Term
T or F
Pessaries can only be managed by physicians. |
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Definition
| False. NPs can manage pessary therapy. |
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Term
| Patients can be educated to reduce their risk of prolapse. What areas should we address? |
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Definition
- Maintain a healthy weight
- Exercise (include Kegels)
- Stop smoking
- Use correct body mechanics when lifting
- Consider ERT peri/post menopause
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