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    Genital Prolapse

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    smbawasaini
    This document discusses genital prolapse and its treatment. It defines the different types of genital prolapse which can occur when the pelvic floor muscles weaken over time, including cystocele, urethrocele, rectocele, and enterocele. Symptoms range from pressure or heaviness in the vaginal region to urinary or bowel incontinence. Treatment options include conservative measures like lifestyle changes and pelvic floor exercises, pharmacological treatments, and various surgical procedures depending on the type of incontinence or prolapse present. The goal is to provide a cure or improvement while discussing risks, benefits, and outcomes of the different approaches.

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    Genital Prolapse

    Uploaded by

    smbawasaini
    128 views13 pages
    This document discusses genital prolapse and its treatment. It defines the different types of genital prolapse which can occur when the pelvic floor muscles weaken over time, including cystocele, urethrocele, rectocele, and enterocele. Symptoms range from pressure or heaviness in the vaginal region to urinary or bowel incontinence. Treatment options include conservative measures like lifestyle changes and pelvic floor exercises, pharmacological treatments, and various surgical procedures depending on the type of incontinence or prolapse present. The goal is to provide a cure or improvement while discussing risks, benefits, and outcomes of the different approaches.

    Original Description:

    genital prolapse: etiology, management and diagnosis

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    This document discusses genital prolapse and its treatment. It defines the different types of genital prolapse which can occur when the pelvic floor muscles weaken over time, including cystocele, urethrocele, rectocele, and enterocele. Symptoms range from pressure or heaviness in the vaginal region to urinary or bowel incontinence. Treatment options include conservative measures like lifestyle changes and pelvic floor exercises, pharmacological treatments, and various surgical procedures depending on the type of incontinence or prolapse present. The goal is to provide a cure or improvement while discussing risks, benefits, and outcomes of the different approaches.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    128 views13 pages

    Genital Prolapse

    Uploaded by

    smbawasaini
    This document discusses genital prolapse and its treatment. It defines the different types of genital prolapse which can occur when the pelvic floor muscles weaken over time, including cystocele, urethrocele, rectocele, and enterocele. Symptoms range from pressure or heaviness in the vaginal region to urinary or bowel incontinence. Treatment options include conservative measures like lifestyle changes and pelvic floor exercises, pharmacological treatments, and various surgical procedures depending on the type of incontinence or prolapse present. The goal is to provide a cure or improvement while discussing risks, benefits, and outcomes of the different approaches.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
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    The passage discusses the anatomy of the pelvic floor and causes of pelvic organ prolapse. It also describes different types of genital prolapse like cystocele, rectocele, and uterine prolapse.

    The main types of genital prolapse discussed are cystocele, urethrocele, rectocele, and enterocele.

    Common symptoms mentioned include a feeling of pressure or heaviness in the vaginal region, sensation of things 'falling out', discomfort in the lower abdomen or back, difficulty emptying the bladder, and difficulty having bowel movements.

    GENITAL PROLAPSE

    DR. IQBAL TURKISTANI Asst. Prof. & Consultant

    The pelvic floor, closing the outlet of the pelvis is made up of a number of muscular and facial structures the most important of which is the LEVATOR ANI.
    These structures are pierced by the RECTUM, VAGINA & URETHRA. passing through the exterior of the body These structures are supported in place by: ligaments condensation of facia

    A relaxed vaginal outlet is usually a sequel to mere OVERSTRETCHING of the perineal supporting tissues as a result of previous parturition Muscular atony and loss of elastic tissue in later life lack of hormone DENERVATION due to damage to perineal or pelvic nerves delivery and pelvic surgery

    TYPES OF GENITAL PROLAPSE


    PELVIC ORGAN PROLAPSE (POP)
    1. CYSTOCELE = As a result of defect in the pubo-cervical facial plane which support the bladder anteriorly = it tends to permit the bladder to sag down below and beyond the uterus URETHROCELE: = when the defective facia involves the urethra RECTOCELE = due to attenuation in the pararectal facia permits the rectum to bulge through ENTEROCELE: = Peritoneal hernial sac along the anterior surface of the rectum = Often contains loops of small intestine

    2. 3.

    4.

    DIAGNOSIS OF POP
    SYMPTOMS:
    Often symptomless Complaints of : Pressure and heaviness in the vaginal region Sensation of everything dropping out Bearing down discomfort in the lower abdomen Backache

    Other associated problems:


    Fecal incontinence (e.g. with complete perineal laceration) and often with loose stools. Difficulty in emptying the bladder with marked cyctocele Cystitis due to residual urine ascending UTI frequency of micturition Urinary incontinence stress incont. Difficulty of defection and constipation with rectocele haemorrhoids

    Lump/mass protruding through is marked prolapse

    SIGNS / EXAMINATION:

    Inspection Gaping introitus Perineal scars Visible cystocele and rectocele / urethral Uterine prolapse Cx. Ulceration (contact) = Decubitus ulcer

    Degree of prolapse

    TREATMENT
    Incontinence
    Objective:
    To provide cure or improvement Treatment options, risks, benefits and outcomes should be discussed.

    POP

    Treatment Options:
    Can be divided into:
    Pharmacologal Conservative Measures Surgical intenvention

    I. CONSERVATIVE TREATMENT:
    Life style interventions Physical therapy (PFMT) / Kegels Exercise Bladder training Electrical stimulation Behavioral strategies Anti- incontinence devices

    II.

    PHARMACOLOGICAL TREATMENT: A. Drug used for Urgency Incont. and OAB.


    i. Antimuscarinic (anticholinergic) agents - Muscanic receptors (M2 & M3) are predominant in the bladder. - These can be blocked by antimuscarinic which act by competing with ACH on the muscarinic receptors mainly during the storage phase e.g. Oxybutinin Tolterodine Solifenacin Darifanacin Propiverine

    Tertiary amines Quarternary amines

    - Very good efficacy profile - Side effects: Dry mouth Constipation Blurred Vision & Cardiovascular effect palpitations / tachycardia - Contraindication: , Narrow angle glucoma

    ii.

    Botulinum Toxin (BTX) - types A & B


    - local intravesical injection - Blocks the release of Ach from parasympathetic nerve endings at the myo-neuronal junction redution in muscle contractility

    B.

    DRUGS FOR SUI:

    Duloxetine
    = combined norepinephrine and serotonin re-uptake inhibitor sphincter muscle activity during filling phase of micturition significant in incont. episode frequency (IEF) >50% from baseline ---> improvement in quality of life

    SIDE EFFECTS:
    - Nausea - Others fatigue, dry mouth, headache, dizzines

    C.

    ESTROGENS
    = Controversiial little effect in the management of SUI

    SURGICAL TREATMENT FOR INCON.


    I. SURGERY FOR SUI:
    1. 2. 3. Intra-urethral injection therapy Cysto-urethropexies Low-tension vaginal tape TVT TOT Classical sling procedures Artificial sphincters

    4. 5.

    II.

    SURGERY FOR URGNECY INCONT. (UUI)


    1. 2. 3. Augmentation cystoplasty Auto-augmentation Sacral nerve stimulation

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