Craig Dyson
Sioned Griffiths
October 2013
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Normal Anatomy
Causes of prolapse
Types of Prolapse
Investigation
Management
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“To fall out”
Protrusion of an organ or structure beyond its
normal confines and with an epithelial surface
Genitourinary prolapse – Descent of one or
more of pelvic organs.
41% of 50-79 year old’s but uncertain
Uterocoele, Cystocoele, Rectocoele, Enterocoele
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Levator Ani/Endopelvic Fascia important
Damage to these structures can occur through:
 Trauma
 Neuropathic Injury
 Disruption/Stretching
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Multifactorial – Orientation of bones may be a
factor.
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Increasing Age
(Double risk with
every decade)
Vaginal Delivery
Increasing parity
Obesity
Spina Bifida
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Pregnancy Variables
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Macrosomia
Prolonged 2nd stage
Episiotomy
Use of
forceps/oxytocin
FH of prolapse
Constipation
Connective Tissue
Disorder
Occupation
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Anterior
Urethrocoele
Urinary Stress
Incontinence
– Rare
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Cystocoele
Increased frequency
– UTI
– Sensation of mass
– No Symptoms
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Both
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Most Common
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Middle
Uterine Prolapse
Vaginal Vault Prolapse
Post Hysterectomy
– Assoc with cystocoele,
rectocoele and
enterocoele.
– Retention
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Enterocoele
Pouch of Douglas
– Cough Impulse
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Posterior
Rectocoele
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Pelvic Organ Prolapse Quantification System
Valsalva - ? Left Lateral
Stage 0
Stage 1 – 1cm above hymen
Stage 2 - Within 1 cm of hymen
Stage 3 - >1cm below plane of hymen but <2cm
of total length of vagina
Stage 4 – Complete eversion of vagina
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General
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Urinary
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Incontinence
Frequency
Coital
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Fullness
Sensation of bulge
Backache
Dypareunia
Flatus
Bowel
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Constipation/Incontinence
Need to apply digital pressure
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History and
Examination
Urinalysis
Post-Voidal Urine
volume testing
Urodynamics
US
Urea/Creatinine
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Conservative
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Watchful Waiting
Lifestyle Modification
Pelvic Floor Exercises
 Evidence?
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Vaginal Oestrogen
Creams
Pessary
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Inserted into vagina to
reduce prolapse
Made of silicon or
plastic or Soaked in
wine…
Good short term
option
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Surgical
Effective
Re-operation required
in 29% of cases
Fitness of patient
Sexually Active
Surgeons Advice
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Anterior Colporrhaphy
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Hysterectomy
Sacrospinous Fixation
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Involves plication of anterior vaginal wall to
reinforce.
Unilateral or bilateral fixation of uterus to
sacrospinous ligament
Sacocolpoplexy
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Mesh used to attach top of vagina to sacrum.
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Prolapse is increasingly common with age.
Can be classified according to compartment or
level of prolapse
Can be clear on examination
Good conservative and surgical options
available
Good prognosis
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Pessary treatment for pelvic organ prolapse and health-related quality of life: a review. Lamers BH, Broekman
BM, Milani AL - Int Urogynecol J (2011)
Rev Urol. 2004; 6(Suppl 5): S2–S10. PMCID: PMC1472875. Female Pelvic Floor Anatomy: The Pelvic Floor,
Supporting Structures, and Pelvic Organs. Sender Herschorn
Herschorn S, Carr LK. In: Campbell’s Urology. 2002:1092–1139.
Rectocele | Vaginal Surgery & Urogynecology Institute .vaginalsurgeryandurogynecologyinstitute.com
Int J Med Sci 2012; 9(10):894-900. doi:10.7150/ijms.4829. Three-dimensional Ultrasound Appearance of Pelvic Floor in
Nulliparous Women and Pelvic Organ Prolapse Women. Tao Ying Corresponding address, Qin Li, Lian Xu, Feifei Liu,
Bing Hu
http://www.patient.co.uk/health/Genitourinary-GU-Prolapse.htm
www.pelvicfloor.com/knowledge/imagelibrary/1/img/1.jpg
www.bristolsurgery.com/images/Preop%20Rectocele.jpg