Pelvic Organ Prolapse: Difference between revisions

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Original Editor - [[User:Laura Ritchie|Laura Ritchie]], posting on behalf of Lauren Kalvaitis, MPT Class of 2016 at [http://www.uwo.ca/fhs/pt/ Western University], project for PT9583<br> Top Contributors - {{Special:Contributors/{{FULLPAGENAME}}}}
</div>  
<div class="editorbox">
Original Editor - [[User:Laura Ritchie|Laura Ritchie]], posting on behalf of Lauren Kalvaitis, MPT Class of 2016 at [http://www.uwo.ca/fhs/pt/ Western University], project for PT9583
 
Top Contributors - {{Special:Contributors/{{FULLPAGENAME}}}}
</div>
 
== Definition/Description  ==
== Definition/Description  ==


[[Image:Pelvic floor.jpg|right]]  
[[Image:Pelvic floor.jpg|right]]  


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 and Gynecology and Reproductive Biology. 2016. 197; 59-62.</ref> 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 and Gynecology and Reproductive Biology. 2016. 197; 59-62.</ref>  


*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>  
There are several types:
*Urethrocele: prolapse of the urethra <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>
*[[Uterine Prolapse|Uterine prolapse]]&nbsp;<ref name="WebMD" /> <br>  
*Urethrocele: prolapse of the urethra  
*Vaginal vault prolapse: prolapse of the vagina&nbsp;<ref name="Vergeldt" /> <br>  
*[[Uterine Prolapse|Uterine prolapse]] <ref name="WebMD" />
*Enterocele: small bowel prolapse <br>
*Vaginal vault prolapse: prolapse of the vagina <ref name="Vergeldt" />
*Rectocele: rectum prolapse&nbsp;<ref name="WebMD" />
*Enterocele: small bowel prolapse
*Rectocele: rectum prolapse <ref name="WebMD" /><br>


== Clinically Relevant Anatomy  ==
== Clinically Relevant Anatomy  ==
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A variety of symptoms may be present including:  
A variety of symptoms may be present including:  


*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>  
*Vaginal bulging <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 heaviness&nbsp;<ref name="Panman" />&nbsp;
*Feeling of pelvic pressure or heaviness <ref name="Panman" />  
*[[Chronic Pelvic Pain|Pelvic pain]]&nbsp;<ref name="Panman" />  
*[[Chronic Pelvic Pain|Pelvic pain]] <ref name="Panman" />  
*Urinary or fecal incontinence or obstruction&nbsp;<ref name="Panman" />  
*Urinary or fecal incontinence or obstruction <ref name="Panman" />  
*Altered daily activities, sexual function and quality of life <ref name="Panman" /><br>
*Altered daily activities, sexual function and quality of life <ref name="Panman" /><br>


Line 41: Line 47:


''Primary Pelvic Organ Prolapse''  
''Primary Pelvic Organ Prolapse''  
 
*Pregnancy and labour <ref name="WebMD" />  
*Pregnancy and labour&nbsp;<ref name="WebMD" />  
*Obesity/BMI <ref name="Isik" />&nbsp;<ref name="Vergeldt" />  
*Obesity/BMI&nbsp;<ref name="Isik" />&nbsp;<ref name="Vergeldt" />&nbsp;
*Respiratory problems involving a chronic, long-term cough <ref name="WebMD" />  
*Respiratory problems involving a chronic, long-term cough&nbsp;<ref name="WebMD" />  
*Cancer of the pelvic organs <ref name="WebMD" />  
*Cancer of the pelvic organs&nbsp;<ref name="WebMD" />  
*Hysterectomy (surgical removal of the uterus) <ref name="WebMD" />  
*Hysterectomy (surgical removal of the uterus)&nbsp;<ref name="WebMD" />  
*Genetics (possibly) due to weaker connective tissues <ref name="WebMD" />  
*Genetics (possibly) due to weaker connective tissues <ref name="WebMD" />  
*History of vaginal delivery increases the risk 5.56 times&nbsp;<ref name="Vergeldt" /> <ref name="Isik" />  
*History of vaginal delivery increases the risk 5.56 times <ref name="Vergeldt" /> <ref name="Isik" />  
*Hypertension and Diabetes Mellitus combined increase the risk by 1.9 times&nbsp;<ref name="Isik" />  
*Hypertension and Diabetes Mellitus combined increase the risk by 1.9 times <ref name="Isik" />  
*Increased birth weight&nbsp;<ref name="Isik" />  
*Increased birth weight <ref name="Isik" />  
*Age&nbsp;<ref name="Vergeldt" />  
*Age <ref name="Vergeldt" />  
*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>
*Parity <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) <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)&nbsp;<ref name="Vergeldt" />
*Preoperative stage 3 or 4 pelvic organ prolapse (i.e. a more severe prolapse) <ref name="Vergeldt" />


== Treatment/Management  ==
== Treatment/Management  ==
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[[Image:Pelvic floor.png|right|250px]]  
[[Image:Pelvic floor.png|right|250px]]  


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" />  
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). <ref name="Panman" />  


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" />  
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. <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. <ref name="Panman" />  


Pelvic floor muscle retraining included:  
Pelvic floor muscle retraining included:  
*Explanation and description of the pelvic floor <ref name="Panman" />
*Instruction regarding how to contract and relax pelvic floor muscles <ref name="Panman" />


*Explanation and description of the pelvic floor&nbsp;<ref name="Panman" />  
#If unable to perform this task, use feedback through digital palpation <ref name="Panman" />  
*Instruction regarding how to contract and relax pelvic floor muscles&nbsp;<ref name="Panman" />
#If insufficient control demonstrated, use myofeedback or electrical stimulation <ref name="Panman" />


#If unable to perform this task, use feedback through digital palpation&nbsp;<ref name="Panman" />
*General exercise program provided, subsequently modified for individual needs <ref name="Panman" />  
#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 pressure <ref name="Panman" />
 
*Received information about washroom habits and lifestyle <ref name="Panman" />  
*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 contraction <ref name="Panman" />  
*Taught correct technique for contracting pelvic floor muscles before and during increases in abdominal pressure <ref name="Panman" />&nbsp;
*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" />
*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" />


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== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) ==
   
<div class="researchbox"><rss>http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=14CrWYUMC68OdZT3Hj</rss></div>
== References  ==
== References  ==


<references />  
<references />  


<br>
[[Category:Condition]] [[Category:Womens Health]] [[Category:Pelvic Health]]
 
[[Category:Articles]][[Category:Condition]][[Category:Videos]] [[Category:Womens Health]]

Revision as of 08:42, 29 August 2017

Original Editor - Laura Ritchie, posting on behalf of Lauren Kalvaitis, MPT Class of 2016 at Western University, project for PT9583

Top Contributors - Laura Ritchie, Temitope Olowoyeye, Kim Jackson, Lucinda hampton, WikiSysop, Vidya Acharya, Evan Thomas, Chelsea Mclene and Kirenga Bamurange Liliane

Definition/Description[edit | edit source]

Pelvic floor.jpg

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 vagina [3]
  • 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]

[5]

The factors causing pelvic organ prolapse are different between patients.[3] Risk factors include the following:

Primary Pelvic Organ Prolapse

  • Pregnancy and labour [2]
  • Obesity/BMI [1] [3]
  • Respiratory problems involving a chronic, long-term cough [2]
  • 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 risk 5.56 times [3] [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) [6]

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]

Pelvic floor.png

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]

Presentations[edit | edit source]

http://www.youtube.com/watch?v=w08iCzxnQBUKegel or not.png
 Pelvic Physiotherapy - to Kegel or Not?

This presentation was created by Carolyn Vandyken, a physiotherapist who specializes in the treatment of male and female pelvic dysfunction. She also provides education and mentorship to physiotherapists who are similarly interested in treating these dysfunctions. In the presentation, Carolyn reviews pelvic anatomy, the history of Kegel exercises and what the evidence tells us about when Kegels are and aren't appropriate for our patients.

View the presentation

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 and Gynecology and Reproductive Biology. 2016. 197; 59-62.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 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 3.5 3.6 3.7 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. ↑ the study spot. Uterine Prolapse and Vaginal Prolapse for USMLE. Available from: http://www.youtube.com/watch?v=YBqUV53_QGU [last accessed 02/09/16]
  6. ↑ 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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