Prolapse
Definition
Protrusion of uterus into or out of vagina
Types
Risk Factors
Aetiology
Defective uterosacral/ cardinal ligaments
Clinical Features
Uterine
Cystocele
Rectocele
Management
Conservative
Surgical
Source
Toronto Notes 2012
Protrusion of uterus into or out of vagina
Types
- Uterine
- Vaginal vault (internal vaginal canal)
- Cystocele (bladder)
- Rectocele (rectum)
- Enterocele (SI)
Risk Factors
- Vaginal childbirth
- Aging
- Decreased estrogen (post-menopause)
- Following pelvic surgery
- Increased intra-abdominal pressure (obesity, chronic cough, constipation, ascites, heavy lifting)
- Congenital (rarely)
- Ethnicity (Caucasian women > Asian or African women)
- Collagen disorders
Aetiology
Defective uterosacral/ cardinal ligaments
Clinical Features
Uterine
- Groin/ back pain (stretching of ligaments)
- Pressure (relieved by lying)
- Ulceration/ bleeding (menstrual)
Cystocele
- Frequency, Urgency, Nocturia
- Stress incontinence
- Incomplete emptying
Rectocele
- Straining/ digitising to defecate
- Constipation
Management
Conservative
- Kegel exercise (strengthen pelvic mm)
- Vagina gel (oestrogen)
- Pessary (mechanical insertion)
Surgical
Source
Toronto Notes 2012