Transcript Pelvic Floor Prolapse - Malcolm Padwick MD, FRCOG

Pelvic Floor Prolapse
M L Padwick MD FRCOG
What is prolapse ?
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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.
Statistics
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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
Factors associated
with pelvic floor
• age prolapse
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parity
big babies
menopause
obesity
occupation
home delivery
family history
Pathogenesis
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childbirth
connective tissue disorders
menopause
chronic intra-abdominal pressure
iatrogenic (hysterectomy)
What are the
symptoms of pelvic
• Thisfloor
depends prolapse?
on the types and the
severity of the prolapse.
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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:
Bladder
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stress incontinence
urgency
frequency
incomplete emptying
dribbling
recurrent urine infections
Bowel
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low back pain or discomfort
incomplete emptying
constipation
manual decompression
incontinence of flatus
Sexual problems
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looseness and lack of sensation
difficult entry and expulsion
discomfort or painful intercourse
vaginal bleeding in neglected cases
Other
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can see and feel it
back ache
dragging sensation
increased discharge
skin irritation
How can prolapse be
prevented?
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appropriate antenatal and intrapartum
care
regular postnatal pelvic floor exercises to
compensate for childbirth damage
in postmenopausal women, oestrogen
cream helps maintain tissue strength
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
Pelvic organ prolapse
Non-surgical
treatments
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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
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.
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.
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.
roduction
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The Surgical
Management of
Prolapses
Principles
of Pelvic Reconstructive
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Surgery
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
The Surgical
Management of
Prolapses
Patient assessment
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Careful history
Physical examination
Neurological assessment
Urodynamic evaluation
Anorectal investigations
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The Surgical
Management of
Prolapses
Factors affecting choice of operation
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
The Surgical
Management of
Prolapses
Summary - Female Pelvic Organ
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Prolapse
Uterovaginal prolapse is multifactorial in
origin
Treatment needs to be individualised
Approach often needs to be
multidisciplinary
Quality of life assessment is essential
Types Of Surgery
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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
Sacrocolpopexy and paravaginal repair
for total pelvic floor prolapse