PROLAPSE1 - Text Content UTERINE PROLAPSE Symptoms mass or bulge at introitus back pain du...
Text Content
UTERINE PROLAPSE Symptoms mass or bulge at introitus back pain due to stretching of uterosacral ligaments feeling of heaviness in the pelvis worse with standing, lifting relieved by lying down Classification 0 = No descent 1 = Descent between normal position and ischial spines 2 = Descent between ischial spines and hymen 3 = Descent with hymen 4 = Descent through hymen Procidentia: failure of genital supports and complete prolapse of uterus Treatment conservative vaginal pessary estrogen therapy pelvic muscle exercises (Kegels) surgical prosthetic slings in cases associated with urinary incontinence vaginal hysterectomy ±anterior + posterior repair VAULT PROLAPSE follows hysterectomy, vagina turns inside out Treatment conservative vaginal pessary estrogen therapy surgical vaginal vault suspension (can be very complicated) CYSTOCELE CYSTOCELE prolapse of bladder into the upper anterior vaginal wall Symptoms frequency, urgency, nocturia stress incontinence incomplete emptying bladder increased incidence of UTIs Treatment conservative vaginal pessary, Kegels exercises surgical anterior colporrhaphy (ìanterior repairî) plication of pubocervical fascia to support bladder and urethra RECTOCELE RECTOCELE prolapse of large bowel in lower posterior vaginal wall Symptoms constipation constant straining may increase rectocele Treatment conservative laxatives and stool softeners vaginal pessary usually not helpful surgical posterior colporrhaphy (ìposterior repairî) plication of endopelvic fascsia and perineal muscles approximated in midline to support rectum/perineum ENTEROCELE ENTEROCELE prolapse of small bowel in upper posterior vaginal wall usually associated with rectocele image Some types of vaginal pessaries used for prolapse. (A) Gellhorn, (B) Shaatz, (C) Ring, (D) ring with support, (E) Cube, (F) Smith, (G) Hodge, (H) Hodge with support for cystocele, (I) Inflatoball, (J) Gehrung, and (K) Donut.
