Pelvic organ prolapse Pelvic Organ Prolapse Most common gynaecological problem. Amongst parous women. A form of hernia. Anatomy of Uterus Anteversion and anteflexion position. Lies between rectum and bladder. Cervix pierces the vagina at the right angle to the axis of vagina. Supports of Uterus Uterus is held in position by 3 tier support system. Upper tier Middle tier Inferior tier. Upper tier Primarily, maintains the uterus in anteverted position. The structures responsible are: Endopelvic fascia. Round ligaments. Broad ligaments. Middle tier Constitutes the strongest support of uterus. Responsible structures are: Pericervical ring. Pelvic cellular tissues. Inferior tier Indirect support of uterus. Responsible structures are pelvic floor muscles including: Levator ani Endopelvic fascia Levator plate Perineal body Urogenital diaphragm Anatomical Factors Gravitational stress. Parturition stress. Pelvic floor weakness. Inherent weakness of supporting structures. Acquired Predisposing Factors Trauma of vaginal delivery causing injury : Ligaments Endopelvic fascia Levator muscle Perineal body Pudendal nerve and muscle damage due to repeated child birth. Congenital Predisposing Factors Inborn weakness of supporting structure. Aggravating factors Post menopausal atrophy Poor collagen tissue repair with age. Increased intra abdominal pressure. Occupational hazards Asthenia Obesity Fibroid/Polyp Clinical Degrees Of Uterine Prolapse Symptoms Feeling of something coming out per vaginum. Backache or dragging pain in pelvis Dyspareunia Urinary symptoms Bowel symptoms Clinical examination Inspection and palpation. General examination. Pelvic examination Uterine prolapse Management of Prolapse Preventive Conservative Surgery Preventive Measures Pelvic floor exercise during puerperium. Avoid strenuous activities. Avoiding prolonged cough. Avoiding constipation. Avoiding heavy weight lifting. Avoiding future pregnancy too early. Conservative Management Indications : Asymptomatic women Mild degree prolapse POP in early pregnancy Treatment : Oestrogen replacement therapy. Kegel exercise Pessary treatment Surgical Management of Prolapse Restorative Extirpative Obliterative

1. Pelvic Organ Prolapse
Dr. Yashika

2. Pelvic Organ Prolapse
• Most common gynaecological problem.
• Amongst parous women.
• A form of hernia.

3. Anatomy of Uterus
• Anteversion and
anteflexion position.
• Lies between rectum and
bladder.
• Cervix pierces the vagina at
the right angle to the axis
of vagina.

6. Supports of Uterus
Uterus is held in position by 3 tier support system.
1. Upper tier
2. Middle tier
3. Inferior tier.

7. Upper tier
Primarily, maintains the uterus in anteverted position.
The structures responsible are:
1. Endopelvic fascia.
2. Round ligaments.
3. Broad ligaments.

8. Middle tier
Constitutes the strongest support of uterus.
Responsible structures are:
1. Pericervical ring.
2. Pelvic cellular tissues.

9. Inferior tier
Indirect support of uterus.
Responsible structures are pelvic floor muscles including:
1. Levator ani
2. Endopelvic fascia
3. Levator plate
4. Perineal body
5. Urogenital diaphragm

10. Aetiology of POP
Anatomical Clinical
Predisposing
Acquired Congenital
Aggravating

11. Anatomical Factors
• Gravitational stress.
• Parturition stress.
• Pelvic floor weakness.
• Inherent weakness of supporting structures.

12. Acquired Predisposing Factors
Trauma of vaginal delivery causing injury :
1. Ligaments
2. Endopelvic fascia
3. Levator muscle
4. Perineal body
5. Pudendal nerve and muscle damage due to
repeated child birth.

13. Congenital Predisposing Factors
• Inborn weakness of supporting structure.

14. Aggravating factors
• Post menopausal atrophy
• Poor collagen tissue repair with age.
• Increased intra abdominal pressure.
• Occupational hazards
• Asthenia
• Obesity
• Fibroid/Polyp

15. Types of POP
Vaginal Prolapse
Anterior wall
Posterior wall
Uterine Prolapse
Uterovaginal prolapse
Congenital prolapse

16. Vaginal
Prolapse
Anterior wall
Cystocele Urethrocele
Posterior wall
Relaxed
perineu
m
Rectocele
Vault
Prolapse

18. Clinical Degrees Of Uterine Prolapse

19. Symptoms
• Feeling of something coming out per vaginum.
• Backache or dragging pain in pelvis
• Dyspareunia
• Urinary symptoms
• Bowel symptoms

20. Clinical examination
• Inspection and palpation.
• General examination.
• Pelvic examination

21. Cystocele
• Bulging of
anterior
vaginal wall
which
increases
when the
patient is
asked to
strain.
Cystoureth
rocele
• Bulging of
anterior
vaginal wall
including
lower one
third also.
Rectocele
• Bulging of
the middle
third of
posterior
vaginal
wall.
Enterocele
• Bulging of
upper third
of posterior
vaginal
wall.

22. Uterine prolapse
First degree
• Descent of cervix below
the level of ischial spine
on straining.
Second/ Third degree
• A protruding mass out
through the introitus.

23. Management of Prolapse
• Preventive
• Conservative
• Surgery

24. Preventive Measures
• Pelvic floor exercise during puerperium.
• Avoid strenuous activities.
• Avoiding prolonged cough.
• Avoiding constipation.
• Avoiding heavy weight lifting.
• Avoiding future pregnancy too early.

25. Conservative Management
Indications :
a. Asymptomatic women
b. Mild degree prolapse
c. POP in early pregnancy
Treatment :
a. Oestrogen replacement therapy.
b. Kegel exercise
c. Pessary treatment

26. Surgical Management of Prolapse
A. Restorative
B. Extirpative
C. Obliterative