Obstetrics and Gynecology · MU Sofia

59. Pelvic floor relaxation. Urinary incontinence

Covers pelvic organ prolapse first, including its causes, the anterior, apical and posterior types with a comparison table, grading systems, symptoms and conservative, pessary and surgical treatment. It then compares stress and urge urinary incontinence in a table covering mechanism, symptoms, investigation and first-line and further treatment, and notes conditions to exclude such as overflow and fistula.

Inside: 2 sections · 2 tables · 16 flashcards · 2 min

Topic 59 of 61 in the MU Sofia syllabus for Obstetrics and Gynecology (Medicine, Year 5). The free AceMed note covers it in 2 sections, about 225 words (2 min of reading), with 16 flashcards.

In this note

  1. Pelvic organ prolapse
  2. Urinary incontinence

Pelvic organ prolapse

Prolapse is the descent of the pelvic organs into or through the vagina, from weakness of the pelvic floor (levator ani) and the connective tissue supports (cardinal and uterosacral ligaments, fascia). Up to half of parous women have some degree; about 10% have surgery.

Risk factors

  • Vaginal childbirth (especially large babies, instrumental, long second stage), ageing and menopause (oestrogen loss), obesity, chronic cough, constipation, heavy lifting, connective tissue disorders, previous hysterectomy.

Types

Grading: classic grades I–III and procidentia (whole uterus outside), or the POP-Q system (stages 0–4).

Symptoms

"Something coming down", a dragging feeling worse at the end of the day, urinary symptoms (incomplete emptying, frequency, incontinence), need to press back the bulge to pass urine or stool (digitation), sexual difficulty, ulceration of a procidentia.

Treatment

  • Conservative: weight loss, treat cough and constipation, pelvic floor muscle training, local oestrogen.
  • Vaginal pessaries (ring, shelf): good for women who want to avoid surgery or are unfit.
  • Surgery: anterior and posterior repair (colporrhaphy), vaginal hysterectomy, sacrospinous fixation, sacrocolpopexy (vault prolapse), Manchester repair; colpocleisis for frail women. Transvaginal mesh is restricted because of complications.

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