Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.
-
Upload
henry-wells -
Category
Documents
-
view
227 -
download
0
Transcript of Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.
![Page 1: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/1.jpg)
Pelvic Floor Prolapse
M L Padwick MD FRCOG
![Page 2: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/2.jpg)
IN THE NAME OF GOD
![Page 3: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/3.jpg)
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.
![Page 4: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/4.jpg)
![Page 5: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/5.jpg)
![Page 6: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/6.jpg)
![Page 7: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/7.jpg)
![Page 8: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/8.jpg)
Statistics
• ratio surgery for prolapse vs incontinence: 2:1
•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
![Page 9: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/9.jpg)
Factors associated with pelvic floor
prolapse•age
•parity
•big babies
•menopause
•obesity
•occupation
•home delivery
• family history
![Page 10: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/10.jpg)
Diagnostic Approach
•fig4
![Page 11: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/11.jpg)
Pathophysiology
•Table 1
![Page 12: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/12.jpg)
Pathogenesis
•childbirth
•connective tissue disorders
•menopause
•chronic intra-abdominal pressure
• iatrogenic (hysterectomy)
![Page 13: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/13.jpg)
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:
![Page 14: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/14.jpg)
Bladder
•stress incontinence
•urgency
• frequency
• incomplete emptying
•dribbling
•recurrent urine infections
![Page 15: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/15.jpg)
Bowel
• low back pain or discomfort
• incomplete emptying
• constipation
• manual decompression
• incontinence of flatus
![Page 16: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/16.jpg)
Sexual problems
• looseness and lack of sensation
• difficult entry and expulsion
• discomfort or painful intercourse
• vaginal bleeding in neglected cases
![Page 17: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/17.jpg)
Other
•can see and feel it
•back ache
•dragging sensation
• increased discharge
•skin irritation
![Page 18: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/18.jpg)
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
![Page 19: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/19.jpg)
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 padExplore alternatives to sexual intercourse
Carry wet wipes
![Page 20: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/20.jpg)
Pelvic organ prolapse Non-
surgical treatments•Physiotherapy - pelvic floor exercises
and
•Hormone Replacement Therapy (HRT) - may be local oestragens
•Vaginal Pessaries - many choices but regular checks and changes needed and best combined with oestragen creams
![Page 21: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/21.jpg)
Genital prolapse and Pelvic floor muscle exercises
SummaryWe found no RCTs or observational studies of
sufficient quality examining the effects of pelvic floor muscle exercises on the symptoms of genital
prolapse.CommentAlthough 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.
![Page 22: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/22.jpg)
Nutrititon.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.
![Page 23: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/23.jpg)
![Page 24: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/24.jpg)
Nonsurgical Management
![Page 25: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/25.jpg)
Nonsurgical Management
![Page 26: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/26.jpg)
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
![Page 27: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/27.jpg)
The Surgical Management of
Prolapses
• Careful history
•Physical examination
•Neurological assessment
•Urodynamic evaluation
•Anorectal investigations
Patient assessment
![Page 28: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/28.jpg)
The Surgical Management of
Prolapses• Surgeons' own expertise, experience and
preference
• Pre-op voiding or bowel dysfunction
• Duration of efficacy
• Complications
• Learning curveof 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
![Page 29: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/29.jpg)
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
![Page 30: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/30.jpg)
Types Of Surgery
•Anterior and posterior repairs
•Vaginal hysterectomy
•Laparoscopic vaginal vault suspension (± mesh)
•Laparoscopic sacrocolpopexy
•Laser Vaginal Rejuvenation
•Designer Laser Vaginoplasty
• Vaginal approach to prolapse repair incorporating mesh
•Laparoscopic paravaginal repairs
![Page 31: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/31.jpg)
![Page 32: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/32.jpg)
![Page 33: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/33.jpg)
Total colpocleisis procedure often coupled
with a tension free vaginal tape (TVT) sling procedure for urinary
incontinence
![Page 34: Pelvic Floor Prolapse M L Padwick MD FRCOG. IN THE NAME OF GOD.](https://reader030.fdocuments.in/reader030/viewer/2022033022/56649ea05503460f94ba31aa/html5/thumbnails/34.jpg)
Sacrocolpopexy and paravaginal repairSacrocolpopexy and paravaginal repairfor total pelvic floor prolapsefor total pelvic floor prolapse