Female pelvic organ prolapse (POP) refers to the displacement and descent of pelvic organs caused by the defect or relaxation of the pelvic floor supporting tissue, such as vaginal front and rear wall bulge, vaginal vault prolapse, uterine prolapse, which can cause urination Or difficulty defecation, sexual dysfunction, etc. POP is a common disease among women, affecting approximately 40% of women over 40 years old, and this proportion is expected to increase as the population ages. Due to prolapse, patients may experience symptoms such as vaginal foreign body sensation, pain, and dyspareunia, which seriously affects the patient's quality of life and may cause serious psychosocial problems.
1. Pathogenesis:
POP refers to a defect in the pelvic fascia, or a defect in the ligaments or muscles that support the pelvic organs, causing one or more parts of the vaginal front and back walls, the uterus (cervix) or the top of the vagina to deviate from the normal anatomical position. decline.
POP According to the affected pelvic floor chamber, it can be divided into three chambers: anterior, middle and posterior. The anterior chamber includes the bladder, bladder neck, and urethra; the middle chamber includes the uterus or vaginal vault after hysterectomy; and the posterior chamber includes the rectum and anal canal.
Anterior vaginal wall prolapse, also known as cystocele, is an anterior chamber prolapse, which is manifested by the bladder descending backward into the genital hiatus, toward the vaginal entrance.
Posterior vaginal wall prolapse, also known as rectocele, refers to rectum protruding forward into the perineal body, compressing the posterior vaginal wall; posterior vaginal wall bulge is often accompanied by uterine-rectal fossa hernia, if the content of the hernia is intestinal tube, It's called intestinal hernia.
When the uterus descends along the vagina from its normal position, and the external cervical opening reaches below the level of the ischial spine, or even the entire uterus protrudes outside the vaginal opening, it is called uterine prolapse.
Vaginal vault prolapse is prone to occur if the supporting structure at the top of the vagina is defective after hysterectomy.
Promoting factors are:
Age and Increased abdominal pressure , obesity, constipation, chronic cough, repeated physical labor, etc. The most likely mechanism for POP to occur is by causing chronic increased abdominal pressure, which leads to excessive tension in the pelvic structure and pelvic floor muscles. And the fascia becomes weak, the nerves that control the pelvic floor are damaged, and the pelvic floor support function is destroyed. Stimulating factors include pregnancy and childbirth. During childbirth, different modes of delivery cause POP to occur differently.
2. Non-surgical treatment:
In clinical work, usually only women who have symptoms related to prolapse will seek treatment. POP treatment plans are individualized. Non-surgical treatment is usually used for mild patients with POP-QI-II degrees. It is also suitable for severe prolapse patients with POP-QIII-IV degrees who have contraindications to surgery and have no desire for surgery.
1. Pelvic floor muscle exercise:
actively contracts the pelvic floor muscles mainly levator ani to enhance the strength of the pelvic floor support tissue. It is suitable for patients with POP-QI-II degree POP.
2. Pessary :
is a device that supports the uterus and vaginal walls and keeps them in the vagina. It can restore the pelvic organs to their anatomical positions and is a simple, economical and safe way to treat pelvic organ prolapse. , effective treatment methods.
Indications for pessary:
① Those who are unwilling to undergo surgical treatment;
② Those who have clinical symptoms and are willing to wear a pessary;
③ Those who have serious underlying diseases and cannot tolerate surgical treatment; ④ Those who have failed surgery and have an increased risk of adverse reoperations ;
⑤ Pregnancy and those who have not completed childbirth;
⑥ Those who need experimental treatment before POP surgical treatment;
⑦ Understand whether POP patients are complicated by latent urinary incontinence;
⑧ Those who need to temporarily postpone surgery due to career, family or childbearing requirements.
Contraindications of pessary:
① Those who have active vaginitis or pelvic inflammatory disease ;
② Those who have severe vaginal ulcers or vaginal atrophy;
③ Those who are allergic to silicone or rubber;
④ Those who are unwilling to wear it or cannot guarantee follow-up. ;
⑤ Those with cognitive dysfunction or poor hands-on ability;
⑥ Those with malignant tumors of the reproductive system.
3. Prevention:
Promote the prevention and treatment of POP, promote eugenics and nurturing, avoid multiple births, reasonably control the progress of labor, effectively guide delivery, perform PFMT in a timely manner, control weight, quit smoking and drinking, and improve bad living habits. Avoid overexertion and long-term weight bearing. People suffering from diseases that cause chronic increased abdominal pressure, such as chronic cough and constipation, should be actively treated.
The treatment principle of pelvic organ prolapse is:
Asymptomatic patients do not need treatment. Symptomatic patients should be treated conservatively or surgically, and the treatment plan should be individualized. Treatment is based on the principles of safety, simplicity and effectiveness.
Author: Zhejing
Source: Public account of the Department of Obstetrics and Gynecology of Xijiao First Affiliated Hospital
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