Pelvic Organ Prolapse: Difference between revisions

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== Definition/Description  ==
== Definition/Description  ==


Pelvic organ prolapse is the descent of a pelvic organ into or outside of the vaginal canal or anus. It mainly results from pelvic floor dysfunction1. There are several types:  
Pelvic organ prolapse is the descent of a pelvic organ into or outside of the vaginal canal or anus. It mainly results from pelvic floor dysfunction.<ref name="Isik">Isık H, Aynıoglu O, Sahbaz A, Selimoglu R, Timur H, Harma, M. Are hypertension and diabetes mellitus risk factors for pelvic organ prolapse? European Journal of Obstetrics &amp; Gynecology and Reproductive Biology. 2016. 197; 59-62.</ref> There are several types:  


*Cystocele: prolapse of the bladder into the vagina5 <br>
*Cystocele: prolapse of the bladder into the vagina&nbsp;<ref name="WebMD">WebMD. (n.d.). What Is Pelvic Organ Prolapse? Retrieved March 30, 2016, from http://www.webmd.com/urinary-incontinence-oab/pelvic-organ-prolapse</ref> <br>  
*Urethrocele: prolapse of the urethra <br>
*Urethrocele: prolapse of the urethra <br>  
*Uterine prolapse5 <br>
*Uterine prolapse&nbsp;<ref name="WebMD" /> <br>  
*Vaginal vault prolapse: prolapse of the vagina4 <br>
*Vaginal vault prolapse: prolapse of the vagina4 <br>  
*Enterocele: small bowel prolapse <br>
*Enterocele: small bowel prolapse <br>  
*Rectocele: rectum prolapse5
*Rectocele: rectum prolapse&nbsp;<ref name="WebMD" />


== Clinically Relevant Anatomy  ==
== Clinically Relevant Anatomy  ==


Please see [[Pelvic_Floor_Anatomy|this page]] for a detailed overview of pelvic floor anatomy
Please see [[Pelvic Floor Anatomy|this page]] for a detailed overview of pelvic floor anatomy  


== Etiology  ==
== Etiology  ==


Pelvic organ prolapse has a multifactorial etiology. It is likely caused by a combination of physiological, anatomical, reproductive, genetic, and lifestyle factors that interact and contribute to dysfunction of the pelvic floor4.  
Pelvic organ prolapse has a multifactorial etiology. It is likely caused by a combination of physiological, anatomical, reproductive, genetic, and lifestyle factors that interact and contribute to dysfunction of the pelvic floor.&nbsp;<ref name="Vergeldt">Vergeldt TF, Weemhoff M, Inthout J, and Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: A systematic review. International Urogynecology Journal Int Urogynecol J. 2015. 26(11); 1559-1573.</ref>


== Symptoms  ==
== Symptoms  ==


A variety of symptoms may be present, including:  
A variety of symptoms may be present including:  


*Vaginal bulging2
*Vaginal bulging&nbsp;<ref name="Panman">Panman C, Wiegersma M, Kollen B, Berger M, Leeuwen YL, Vermeulen K, Dekker J. Two-year effects and cost-effectiveness of pelvic floor muscle training in mild pelvic organ prolapse: A randomised controlled trial in primary care. BJOG: Int J Obstet Gy. 2016 Mar 21. doi: 10.1111/1471-0528.13992.</ref>
*Feeling of pelvic pressure or heaviness2
*Feeling of pelvic pressure or heaviness&nbsp;<ref name="Panman" />&nbsp;
*Pelvic pain2
*Pelvic pain&nbsp;<ref name="Panman" />
*Urinary or fecal incontinence or obstruction2
*Urinary or fecal incontinence or obstruction&nbsp;<ref name="Panman" />
*Altered daily activities, sexual function, and quality of life2<br>
*Altered daily activities, sexual function, and quality of life <ref name="Panman" /><br>


== Risk Factors  ==
== Risk Factors  ==
Line 34: Line 34:
''Primary Pelvic Organ Prolapse''  
''Primary Pelvic Organ Prolapse''  


*Pregnancy and labour5
*Pregnancy and labour&nbsp;<ref name="WebMD" />
*Obesity/BMI1,4
*Obesity/BMI&nbsp;<ref name="Isik" />&nbsp;<ref name="Vergeldt" />&nbsp;
*Respiratory problems involving a chronic, long-term cough5  
*Respiratory problems involving a chronic, long-term cough5  
*Cancer of the pelvic organs5
*Cancer of the pelvic organs&nbsp;<ref name="WebMD" />
*Hysterectomy (surgical removal of the uterus)5
*Hysterectomy (surgical removal of the uterus)&nbsp;<ref name="WebMD" />
*Genetics (possibly) (due to weaker connective tissues)5
*Genetics (possibly) (due to weaker connective tissues)&nbsp;<ref name="WebMD" />
*History of vaginal delivery increases the risk4 5.56 times1
*History of vaginal delivery increases the risk4 5.56 times&nbsp;<ref name="Isik" />
*Hypertension and Diabetes Mellitus combined increase the risk by 1.9 times1
*Hypertension and Diabetes Mellitus combined increase the risk by 1.9 times&nbsp;<ref name="Isik" />
*Increased birth weight1
*Increased birth weight&nbsp;<ref name="Isik" />
*Age4
*Age&nbsp;<ref name="Vergeldt" />
*Parity4 (i.e. the number of times a woman has given birth to a fetus with a gestational age of greater than or equal to 24 weeks, alive or stillborn)3
*Parity&nbsp;<ref name="Vergeldt" /> (i.e. the number of times a woman has given birth to a fetus with a gestational age of greater than or equal to 24 weeks, alive or stillborn)&nbsp;<ref name="Patient">Patient. (n.d.). Gravidity and Parity Definitions (Implications in Risk Assessment) | Patient. Retrieved March 30, 2016, from http://patient.info/doctor/gravidity-and-parity-definitions-and-their-implications-in-risk-assessment</ref>


''Pelvic Organ Prolapse Recurrence'' (after native tissue repair)  
''Pelvic Organ Prolapse Recurrence'' (after native tissue repair)  


*Preoperative stage 3 or 4 pelvic organ prolapse (i.e. a more severe prolapse)4
*Preoperative stage 3 or 4 pelvic organ prolapse (i.e. a more severe prolapse)&nbsp;<ref name="Vergeldt" />


== Treatment/Management  ==
== Treatment/Management  ==


Treatment for pelvic organ prolapse usually involves either conservative management (for mild prolapse or women who are not good surgical candidates) or surgery. Conservative treatments include pelvic floor muscle training and the use of devices (pessaries)2.  
Treatment for pelvic organ prolapse usually involves either conservative management (for mild prolapse or women who are not good surgical candidates) or surgery. Conservative treatments include pelvic floor muscle training and the use of devices (pessaries).&nbsp;<ref name="Panman" />


In a study by Panman et al. in 2016, examining the 2-year effects of pelvic floor muscle retraining, it was demonstrated that in women aged 55 and greater with symptomatic mild pelvic organ prolapse, pelvic floor muscle retraining results in a significant decrease in pelvic floor symptoms when compared to watchful waiting (note: statistically significant but below the minimal clinically important difference). Additionally, it was found that pelvic floor muscle retraining was more effective in women who experienced increased pelvic floor symptom distress at baseline2. Conversely, the same study found no difference in sexual functioning, quality of life, function of the pelvic floor muscles, or degree of prolapse2.  
In a study by Panman et al in 2016, examining the two-year effects of pelvic floor muscle retraining, it was demonstrated that in women aged 55 and greater with symptomatic mild pelvic organ prolapse, pelvic floor muscle retraining results in a significant decrease in pelvic floor symptoms when compared to watchful waiting (note: statistically significant but below the minimal clinically important difference). <ref name="Panman" />Additionally, it was found that pelvic floor muscle retraining was more effective in women who experienced increased pelvic floor symptom distress at baseline.&nbsp;<ref name="Panman" /> Conversely, the same study found no difference in sexual functioning, quality of life, function of the pelvic floor muscles, or degree of prolapse.&nbsp;<ref name="Panman" />


Pelvic floor muscle retraining included:  
Pelvic floor muscle retraining included:  


*Explanation and description of the pelvic floor2
*Explanation and description of the pelvic floor&nbsp;<ref name="Panman" />
*Instruction regarding how to contract and relax pelvic floor muscles2
*Instruction regarding how to contract and relax pelvic floor muscles&nbsp;<ref name="Panman" />
#If unable to perform this task, use feedback through digital palpation2
 
#If insufficient control demonstrated, use myofeedback or electrical stimulation2
#If unable to perform this task, use feedback through digital palpation&nbsp;<ref name="Panman" />
*General exercise program provided, subsequently modified for individual needs2
#If insufficient control demonstrated, use myofeedback or electrical stimulation&nbsp;<ref name="Panman" />
*Taught correct technique for contracting pelvic floor muscles before and during increases in abdominal pressure2
 
*Received information about washroom habits and lifestyle2
*General exercise program provided, subsequently modified for individual needs&nbsp;<ref name="Panman" />
*If pelvic floor muscles were overactive, focus was on relaxation rather than contraction2
*Taught correct technique for contracting pelvic floor muscles before and during increases in abdominal pressure <ref name="Panman" />&nbsp;
*Face-to-face contact with physiotherapist as well as encouragement to maintain practice at home 3-5 times per week, 2-3 times per day2
*Received information about washroom habits and lifestyle&nbsp;<ref name="Panman" />
*If pelvic floor muscles were overactive, focus was on relaxation rather than contraction <ref name="Panman" />&nbsp;
*Face-to-face contact with physiotherapist as well as encouragement to maintain practice at home 3-5 times per week, 2-3 times per day&nbsp;<ref name="Panman" />


== References  ==
== References  ==
<references />


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Revision as of 19:19, 2 September 2016

Definition/Description[edit | edit source]

Pelvic organ prolapse is the descent of a pelvic organ into or outside of the vaginal canal or anus. It mainly results from pelvic floor dysfunction.[1] There are several types:

  • Cystocele: prolapse of the bladder into the vagina [2]
  • Urethrocele: prolapse of the urethra
  • Uterine prolapse [2]
  • Vaginal vault prolapse: prolapse of the vagina4
  • Enterocele: small bowel prolapse
  • Rectocele: rectum prolapse [2]

Clinically Relevant Anatomy[edit | edit source]

Please see this page for a detailed overview of pelvic floor anatomy

Etiology[edit | edit source]

Pelvic organ prolapse has a multifactorial etiology. It is likely caused by a combination of physiological, anatomical, reproductive, genetic, and lifestyle factors that interact and contribute to dysfunction of the pelvic floor. [3]

Symptoms[edit | edit source]

A variety of symptoms may be present including:

  • Vaginal bulging [4]
  • Feeling of pelvic pressure or heaviness [4] 
  • Pelvic pain [4]
  • Urinary or fecal incontinence or obstruction [4]
  • Altered daily activities, sexual function, and quality of life [4]

Risk Factors[edit | edit source]

The factors causing pelvic organ prolapse are different between patients4. Risk factors include the following:

Primary Pelvic Organ Prolapse

  • Pregnancy and labour [2]
  • Obesity/BMI [1] [3] 
  • Respiratory problems involving a chronic, long-term cough5
  • Cancer of the pelvic organs [2]
  • Hysterectomy (surgical removal of the uterus) [2]
  • Genetics (possibly) (due to weaker connective tissues) [2]
  • History of vaginal delivery increases the risk4 5.56 times [1]
  • Hypertension and Diabetes Mellitus combined increase the risk by 1.9 times [1]
  • Increased birth weight [1]
  • Age [3]
  • Parity [3] (i.e. the number of times a woman has given birth to a fetus with a gestational age of greater than or equal to 24 weeks, alive or stillborn) [5]

Pelvic Organ Prolapse Recurrence (after native tissue repair)

  • Preoperative stage 3 or 4 pelvic organ prolapse (i.e. a more severe prolapse) [3]

Treatment/Management[edit | edit source]

Treatment for pelvic organ prolapse usually involves either conservative management (for mild prolapse or women who are not good surgical candidates) or surgery. Conservative treatments include pelvic floor muscle training and the use of devices (pessaries). [4]

In a study by Panman et al in 2016, examining the two-year effects of pelvic floor muscle retraining, it was demonstrated that in women aged 55 and greater with symptomatic mild pelvic organ prolapse, pelvic floor muscle retraining results in a significant decrease in pelvic floor symptoms when compared to watchful waiting (note: statistically significant but below the minimal clinically important difference). [4]Additionally, it was found that pelvic floor muscle retraining was more effective in women who experienced increased pelvic floor symptom distress at baseline. [4] Conversely, the same study found no difference in sexual functioning, quality of life, function of the pelvic floor muscles, or degree of prolapse. [4]

Pelvic floor muscle retraining included:

  • Explanation and description of the pelvic floor [4]
  • Instruction regarding how to contract and relax pelvic floor muscles [4]
  1. If unable to perform this task, use feedback through digital palpation [4]
  2. If insufficient control demonstrated, use myofeedback or electrical stimulation [4]
  • General exercise program provided, subsequently modified for individual needs [4]
  • Taught correct technique for contracting pelvic floor muscles before and during increases in abdominal pressure [4] 
  • Received information about washroom habits and lifestyle [4]
  • If pelvic floor muscles were overactive, focus was on relaxation rather than contraction [4] 
  • Face-to-face contact with physiotherapist as well as encouragement to maintain practice at home 3-5 times per week, 2-3 times per day [4]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Isık H, Aynıoglu O, Sahbaz A, Selimoglu R, Timur H, Harma, M. Are hypertension and diabetes mellitus risk factors for pelvic organ prolapse? European Journal of Obstetrics & Gynecology and Reproductive Biology. 2016. 197; 59-62.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 WebMD. (n.d.). What Is Pelvic Organ Prolapse? Retrieved March 30, 2016, from http://www.webmd.com/urinary-incontinence-oab/pelvic-organ-prolapse
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Vergeldt TF, Weemhoff M, Inthout J, and Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: A systematic review. International Urogynecology Journal Int Urogynecol J. 2015. 26(11); 1559-1573.
  4. ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 Panman C, Wiegersma M, Kollen B, Berger M, Leeuwen YL, Vermeulen K, Dekker J. Two-year effects and cost-effectiveness of pelvic floor muscle training in mild pelvic organ prolapse: A randomised controlled trial in primary care. BJOG: Int J Obstet Gy. 2016 Mar 21. doi: 10.1111/1471-0528.13992.
  5. ↑ Patient. (n.d.). Gravidity and Parity Definitions (Implications in Risk Assessment) | Patient. Retrieved March 30, 2016, from http://patient.info/doctor/gravidity-and-parity-definitions-and-their-implications-in-risk-assessment


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