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Pelvic Organ Prolapse/Urinary Incontinence

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Pelvic Organ Prolapse/Urinary Incontinence
Dr. Sylvia Ziegenbein
Instructor
Dept. of Obstetrics and Gynecology
Disclosure
 I have nothing to disclose
Objectives
 To present an overview of the prevalence, risk factors
and presenting symptoms of POP.
 Discuss diagnosis of POP.
 Discuss stress urinary incontinence(SUI).
 Review treatments of POP and SUI.
Symptoms of POP
 Pelvic pressure and pain
 Bulge
 SUI
 Urge incontinence
 Defecatory problems
 Splinting the rectum
 Not emptying completely
 Constipation
 Vaginal bleeding and excoriation
Cystocele
Anterior Compartment Prolapse
Rectocele
Posterior Compartment Prolapse
Uterine Prolapse
Vaginal Cuff Prolapse
Apical Compartment Prolapse
Pathophysiology
 Damage to the complex support system
 Hernias
Prevalence
 In the US - 24 % have some POP
 WHI
 34 % had anterior vaginal wall prolapse
 19 % had posterior vaginal wall prolapse
 14 % had uterine prolapse
 Population based surveys


4-10 % report symptoms of pelvic organ prolapse
African-American women report symptoms less often
Risk Factors
 Vaginal births and pregnancy
 3rd and 4th degree tears
 Smoking
 Steroids
 Chronic cough
 Heavy lifting
 Collagen defects
 Marfan’s, Ehlers-Danlos
 Family History
Exam
Work Up for POP
 History
 Physical
 Qtip test for SUI
 Speculum exam


Lying
Standing
 Rectal Exam
POP-Q
POP-Q
Treatments
 Conservative
 Surgical
Conservative Treatments
 Weight loss, eliminate constipation, reduce inciting
activities(coughing, steroids, heavy lifting)
 Physical Therapy
 Pessary
Pessaries and how they fit
Surgical Treatments
 Anterior repair (anterior colporrhaphy)
 Posterior repair (posterior colporrhaphy)
 Perineorrhaphy
 TVT, if SUI
 Hysterectomy
 Apical support procedure
 Sacral colpopexy
 Sacrospinous ligament suspension
 Uterosacral ligament plication
Anterior and Posterior Repairs
Surgery
 Failure
 Dyspareunia
 Pelvic Pain
 Mesh erosion
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