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Pelvic Floor Prolapse

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Prolapse is a condition in which organs, which are normally ... 20% of women on gynaecology waiting lists. 11% lifetime risk of at least one operation ... – PowerPoint PPT presentation

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Title: Pelvic Floor Prolapse


1
Pelvic Floor Prolapse
  • M L Padwick MD FRCOG

2
What is prolapse ?
  • Prolapse is a condition in which organs, which
    are normally supported by the pelvic floor,
    namely the bladder, bowel and uterus, herniate or
    protrude into the vagina. This occurs as a result
    of damage to the muscles and ligaments making up
    the pelvic floor support. At least half of women
    who have children will experience prolapse in
    later life.

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Statistics
  • ratio surgery for prolapse vs incontinence 21
  • prevalence of 31 in women aged 29-59 yrs
  • 20 of women on gynaecology waiting lists
  • 11 lifetime risk of at least one operation
  • re-operation in 30 of cases

8
Factors associated with pelvic floor prolapse
  • age
  • parity
  • big babies
  • menopause
  • obesity
  • occupation
  • home delivery
  • family history

9
Pathogenesis
  • childbirth
  • connective tissue disorders
  • menopause
  • chronic intra-abdominal pressure
  • iatrogenic (hysterectomy)

10
What are the symptoms of pelvic floor prolapse?
  • This depends on the types and the severity of the
    prolapse.
  • Generally, most women are not aware of the
    presence of mild prolapse.
  • When prolapse is moderate or severe, symptoms may
    include sensation of a lump inside the vagina or
    disturbance in the function of the affected
    organs, such as

11
Bladder
  • stress incontinence
  • urgency
  • frequency
  • incomplete emptying
  • dribbling
  • recurrent urine infections

12
Bowel
  • low back pain or discomfort
  • incomplete emptying
  • constipation
  • manual decompression
  • incontinence of flatus

13
Sexual problems
  • looseness and lack of sensation
  • difficult entry and expulsion
  • discomfort or painful intercourse
  • vaginal bleeding in neglected cases

14
Other
  • can see and feel it
  • back ache
  • dragging sensation
  • increased discharge
  • skin irritation

15
How can prolapse be prevented?
  • appropriate antenatal and intrapartum care
  • regular postnatal pelvic floor exercises to
    compensate for childbirth damage
  • in postmenopausal women, oestrogen cream helps
    maintain tissue strength

16
Living with pelvic organ prolapse
Avoid standing for long periods of time.
Do pelvic floor exercises
Prevent or correct constipation
Wear a girdle
Try yoga
Wear a pantyliner or incontinence pad
Explore alternatives to sexual intercourse
Carry wet wipes
17
Pelvic organ prolapse Non-surgical treatments
  • Physiotherapy - pelvic floor exercises and
    vaginal cones
  • Hormone Replacement Therapy (HRT) - may be local
    oestragens
  • Vaginal Pessaries - many choices but regular
    checks and changes needed and best combined with
    oestragen creams

18
Genital prolapse and Pelvic floor muscle
exercises Summary We found no RCTs or
observational studies of sufficient quality
examining the effects of pelvic floor muscle
exercises on the symptoms of genital prolapse.
Comment Although pelvic floor muscle exercises
appear to be effective in reducing the symptoms
of urinary stress incontinence (see benefits of
pelvic floor muscle exercises in stress
incontinence chapter), their usefulness in the
treatment of genital prolapse is unproven.
19
Nutrition Ensure you are getting the right
nutrition Follow dietary recommendations
outlined on the Foundation of Health page. And
for more information on the special dietary
recommendation for prolapse, see the rest of the
chapter on Naturalhealthpractice/Prolapse chapter
which you can download. Supplements The
supplement programme below should be taken for at
least three months in order to achieve best
results Your supplement plan A good
multivitamin and mineral tablet Vitamin C with
bioflavonoids (1000mg twice a day) Vitamin A
(as beta-carotene at 25,000iu per day)
Proanthocyanidins (50 mg per day) Manganese
(5mg per day) Cranberry supplement (only needed
for stress incontinence) At the end of three
months you should reassess your condition and
adjust your supplement programme accordingly.
20
Pelvic Floor Workout Dr Rosie King's Pelvic
Floor Workout Dr Rosie King is an Australian
doctor with a difference! A sex therapist and sex
educator, she has helped thousands of men and
women achieve greater happiness and health
through her counselling practice and her
appearance on healthcare programmes on TV, radio
and articles in health magazines. In her course
of work, Dr Rosie realised that many women suffer
from bladder, bowel and sexual symptoms that are
directly related to the weakness of the pelvic
floor muscles. She also became aware that shyness
and inhibitions prevent many affected women from
seeking medical help and advice.  Women
commonly present with the following problems One
in three women experiences problems with bladder
control Sagging pelvic organs lead to prolapse of
the bladder, bowel and uterus - such problems
require medical attention and potentially a
surgical repair Many women experience reduced
sexual sensitivity after childbirth Many pelvic
floor problems can be prevented by effective
pelvic floor fitness programme that is designed
to keep the pelvic floor muscles in the top
condition. In an audio programme - the Pelvic
Floor Workout - Dr Rosie King tells women of all
ages everything they need to know about keeping
their pelvic floor in top shape.   Graphic
images of pelvic floor, pelvic floor problems and
pelvic floor changes during arousal taken from Dr
Rosie King's information booklet and workout
diary enclosed with the audio CD programme
entitled the Pelvic Floor Workout 
Dr Rosie King's Pelvic Floor Workout audio
programme on a compact disk costs just 15.98
inclusive of VAT.
21
roduction   About the Athena Pelvic   Muscle
Trainer Who can use the Pelvic Muscle Trainer?
                  Home    Why
Athena?    About the Product    Everyday
Questions    Testimonials    News    Medical
Infomation    Contacts        
22
The Surgical Management of Prolapses
  • Restoration of pelvic structures to normal
    anatomical relationship
  • Restore and maintain urinary /or faecal
    continence
  • Maintain coital function
  • Correct co-existing pelvic pathology
  • Obtain a durable result

Principles of Pelvic Reconstructive Surgery
23
The Surgical Management of Prolapses
Patient assessment
  • Careful history
  • Physical examination
  • Neurological assessment
  • Urodynamic evaluation
  • Anorectal investigations

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The Surgical Management of Prolapses
  • Surgeons' own expertise, experience and
    preference
  • Pre-op voiding or bowel dysfunction
  • Duration of efficacy
  • Complications
  • Learning curve
  • Quality of life factors
  • First or repeat surgery
  • The need to treat other pathology
  • Fitness of the patient
  • Underlying pathology
  • Success rates for different procedures

Factors affecting choice of operation
25
The Surgical Management of Prolapses
  • Uterovaginal prolapse is multifactorial in origin
  • Treatment needs to be individualised
  • Approach often needs to be multidisciplinary
  • Quality of life assessment is essential

Summary - Female Pelvic Organ Prolapse
26
Types Of Surgery
  • Anterior and posterior repairs
  • Vaginal hysterectomy
  • Laparoscopic vaginal vault suspension (Â mesh)
  • Laparoscopic sacrocolpopexy
  • Laser Vaginal Rejuvenation
  • Designer Laser Vaginoplasty
  • Vaginal approach to prolapse repair
    incorporating mesh
  • Laparoscopic paravaginal repairs

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Sacrocolpopexy and paravaginal repair for total
pelvic floor prolapse
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