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    Pelvic Organ Prolapse

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    Fitri Rahmaniani
    Pelvic organ prolapse (POP) is defined as the abnormal descent of pelvic organs from their normal position. The pelvic organs that can prolapse include the uterus, anterior vaginal wall (cystocele), and posterior vaginal wall (rectocele). Risk factors include age, menopause, multiple vaginal deliveries, and chronic coughing. Symptoms vary depending on the organ affected but can include pelvic pain, pressure, and problems with urination or bowel movements. Treatment options include pelvic floor exercises, pessaries, and surgery.

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    Pelvic Organ Prolapse

    Uploaded by

    Fitri Rahmaniani
    95 views27 pages
    Pelvic organ prolapse (POP) is defined as the abnormal descent of pelvic organs from their normal position. The pelvic organs that can prolapse include the uterus, anterior vaginal wall (cystocele), and posterior vaginal wall (rectocele). Risk factors include age, menopause, multiple vaginal deliveries, and chronic coughing. Symptoms vary depending on the organ affected but can include pelvic pain, pressure, and problems with urination or bowel movements. Treatment options include pelvic floor exercises, pessaries, and surgery.

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    PELVIC ORGAN PROLAPSE

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    Pelvic organ prolapse (POP) is defined as the abnormal descent of pelvic organs from their normal position. The pelvic organs that can prolapse include the uterus, anterior vaginal wall (cystocele), and posterior vaginal wall (rectocele). Risk factors include age, menopause, multiple vaginal deliveries, and chronic coughing. Symptoms vary depending on the organ affected but can include pelvic pain, pressure, and problems with urination or bowel movements. Treatment options include pelvic floor exercises, pessaries, and surgery.

    Copyright:

    © All Rights Reserved
    95 views27 pages

    Pelvic Organ Prolapse

    Uploaded by

    Fitri Rahmaniani
    Pelvic organ prolapse (POP) is defined as the abnormal descent of pelvic organs from their normal position. The pelvic organs that can prolapse include the uterus, anterior vaginal wall (cystocele), and posterior vaginal wall (rectocele). Risk factors include age, menopause, multiple vaginal deliveries, and chronic coughing. Symptoms vary depending on the organ affected but can include pelvic pain, pressure, and problems with urination or bowel movements. Treatment options include pelvic floor exercises, pessaries, and surgery.

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    PELVIC ORGAN PROLAPSE

    dr.Dika Putrayuda
    Rofi Saputra
    Ravi Sanjani
    Vadyan Haz Kamal

    Pembimbing:
    dr. Edy Fakhrizal, Sp.OG(K)
    KEPANITERAAN KLINIK BAGIAN OBSTETRI DAN GINEKOLOGI
    PROGRAM PENDIDIKAN DOKTER SPESIALIS OBSTETRI DAN GINEKOLOGI
    FAKULTAS KEDOKTERAN UNIVERSITAS RIAU
    RUMAH SAKIT UMUM DAERAH ARIFIN ACHMAD
    PEKANBARU
    2021
    PELVIC ORGAN PROLAPSE

     POP is defined as abnormal descent or herniation of the pelvic organs from their
    attachment or normal position within the pelvic cavity. Pelvic organs that may be
    involved include the uterus (uterine prolapse) or the tip of the vagina (apical vaginal
    prolapse), anterior vagina (cystocele), or posterior vagina (rectocele)
    ETIOLOGY

     age
     Menopause
     Multiparity
     obstetric trauma
     chronic cough
     Lifting heavy objects
    CLINICAL SYMPTOMS

     Pelvic pain and back pain Women with POP often complain of symptoms of
     the urinary system problem like stress incontinence due to urethral incompetence., urethral obstruction occurred in
    58% of women with grade anterior vaginal prolapse 3 and 4, compared to only 4% in grades 1 and 2
     Symptoms of bowel movements such as straining for too long, emptying the rectum does not complete,
     women with prolapse avoid vaginal sexual contact out of shame. The other woman has experienced urinary
    incontinence (IU) or pelvic incontinence
    THERAPY

     Observation
     Non operative treatment
     Operative
    CYSTOCELE
    DEFINITION

     Anterior vaginal prolapse, also known as a cystocele or a prolapsed bladder, is when


    the bladder drops from its normal position in the pelvis and pushes on the wall of the
    vagina.
    CLASSIFICATION

     Grade 1 (mild): The bladder drops only a short way into the vagina.
     Grade 2 (moderate): The bladder drops to the opening of the vagina.
     Grade 3 (severe): The bladder bulges through the opening of the vagina
    ETIOLOGY

     Pregnancy and vaginal childbirth


     Being overweight or obese
     Repeated heavy lifting
     Straining with bowel movements
     A chronic cough or bronchitis
    RISK FACTOR

     Pregnancy and childbirth. Women who have had a vaginal or instrument-assisted delivery, multiple
    pregnancies, or whose infants had a high birth weight have a higher risk of anterior prolapse.
     Aging. Your risk of anterior prolapse increases as you age. This is especially true after menopause,
    when your body's production of estrogen — which helps keep the pelvic floor strong — decreases.
     Hysterectomy. Having your uterus removed may contribute to weakness in your pelvic floor, but this is
    not always the case.
     Genetics. Some women are born with weaker connective tissues, making them more susceptible to
    anterior prolapse.
     Obesity. Women who are overweight or obese are at higher risk of anterior prolapse
    CLINICAL SYMPTOMS

     A feeling of fullness or pressure in your pelvis and vagina


     In some cases, a bulge of tissue in your vagina that you can see or feel
     Increased pelvic pressure when you strain, cough, bear down or lift
     Problems urinating, including difficulty starting a urine stream, the feeling that you
    haven't completely emptied your bladder after urinating, feeling a frequent need to
    urinate or leaking urine (urinary incontinence)
    THERAPY

     Medical treatment:
     Pelvic floor muscle exercises.
     A supportive device (pessary)
     Ring Pessary
     Donut Pessary
     Gellhorn Pessary

     Surgery
    PROLAPS UTERI
    DEFINITION

     Uterine prolapse is a downward shift in the position of the uterus so that the cervix is ​
    in the vaginal orifice (degree 1). the cervix is ​outside the orifice (degree 2) or the
    entire uterus is outside the orifice (degree 3)
    ETIOLOGY

     Uterine prolapse is caused by weakness pelvic support tissue, including muscles,


    ligaments and fascia. Generally, this condition usually caused by obstetric trauma and
    laceration during labor
    RISK FACTOR

     Age
    35-44 years old, 45-64 years old , > 65 years old
     Parity
    1-2 children, > 2 children Menopause
     Number of vaginal deliveries
    < 2 or > 2 Number of cesarean deliveries
     Uterine prolapse disorders
     Feeling full in the vagina
    • Palpable lump from birth canal
    • Low back pain Uterine prolapse grade - Degree 1, Degree 2, Degree 3, Degree 4
    SIGNS AND SYMPTOMS

     A feeling of lump and prominence in the external genitalia


     Pain in the hips and waist
     lekore
    TREATMENT

     Conservative therapy is subdivided into: Kegel exercises and attach a


    pessary.
     Operative therapy
    RECTOCELE
    DEFINITION

     Rectocele is a herniation or protrusion of the anterior wall of the rectum


    against the posterior vaginal wall in such a way that the anterior wall of
    the rectum is directly opposite the vaginal epithelium.
    CLASSIFICATION

     Low (damage at level III DeLancey): defect in the distal fascia that attaches the
    perineal body.
     Middle (damage at level II DeLancey): defect in the endopelvic fascia extending to
    the rectovaginal septum and pararectal fascia, arising above the levator hiatus.
     High (damage at level I DeLancey): defect proximal to the uterosacral and cardinal
    ligament complex, usually secondary to weakness of the upper rectovaginal septum
    due to enterocele. Upper rectovaginal septum due to enterocele.
     The combination of all three
    ETIOLOGY

    The etiology of rectocele is multifactorial, the suspected cause is stretching and tearing
    of the rectovaginal septum and surrounding tissue which is generally caused by:
     Vaginal delivery
     Chronic increase in intra-abdominal pressure
     High BMI, estrogen deficiency, chronic constipation
     Congenital weakness in the pelvic organ support system
    CLINICAL SYMPTOMS
     Feeling of a mass or bulge in the vagina
     Pelvic pressure or pain
     Lower back pain
     Difficulty with intravaginal intercourse.

    Complaints directly related to rectocele:


     defecation dysfunction
     Inability to completely empty the rectum without straining
     Chronic constipation
     Rectal prolapse
     Dyspareunia (pain during sexual intercourse)
    THERAPY

     Pelvic floor exercises (Kegel exercises) to strengthen the pelvic floor muscles
     Stimulation of the muscles with an electric device to stimulate contraction of the
    muscles
     pelvic floor muscles
     Estrogen hormone therapy in menopausal patients
     Operative treatment: Posterior colporrhaphy
    THANK YOU

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