Genital prolaps
Senast uppdaterad: Senast reviderad:
Sakkunnig:Barbro Larson
Defintion:
Sänkning av ett eller flera bäckenorgan ner mot vaginalöppningen, såsom urinblåsan, tarmen, livmodern eller vaginaltoppen om livmodern är bortopererad.
Förekomst:
Prevalens av kliniskt signifikant prolaps uppges vara runt 3–6 %
Symtom:
Måttlig prolaps ger få eller inga symtom. Vid mer uttalade förändringar märks tryck- och tyngdkänsla i underlivet, och det kan komma ut en bula ur slidan. Tilläggssymtom som kan förekomma är blåstömningsproblem, trängningar, urininkontinens, svårigheter att tömma tarmen, inkontinens för gas och avföring och samlagssvårigheter.
Kliniska fynd:
Prolaps kan provoceras fram i gynekologiskt läge.
Diagnostik:
Tilläggsundersökningar behövs vanligen inte, eventuellt kan urodynamisk undersökning vara av värde vid samtidig inkontinens eller för att avslöja dold ansträngningsinkontinens.
Behandling:
Bäckenbottenträning, viktminskning, eventuellt pessar, lokalt östrogen eller kirurgi.
- Kuncharapu I, Majeroni BA, Johnson DW. Pelvic organ prolapse. Am Fam Physician 2010; 81: 1111-7. American Family Physician
- ACOG Committee on Practice Bulletins - Gynecology. ACOG Practice Bulletin No. 85: Pelvic organ prolapse. Obstet Gynecol 2007; 110: 717-29. PubMed
- Baden WF, Walker TA, Lindsay HJ. The vaginal profile. Tex Med J, 1968; 64: 56-8.
- Bump RC, Mattiasson A, Bo K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996; 175: 10-7. PubMed
- Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J. 2013;24(11):1783-90. PMID: 24142054. PubMed
- Prevalence of symptomatic pelvic organ prolapse in a swedish population. Tegerstedt G, Maehle-Schmidt M, Nyren O, Hammarström M.Int.Urogynecol. Pelvic floor Dysfunct. 2005 nov-dec 16(6)497-503. PMID: 15986100 PubMed
- Nygaard I, Barber MD, Burgio KL et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA 2008; 300: 1311-6. Journal of the American Medical Association
- Schaffer JI, Wai CY, Boreham MK. Etiology of pelvic organ prolapse. Clin Obstet Gynecol 2005; 48: 639-47. PubMed
- Chiaffarino F, Chatenoud L, Dindelli M et al. Reproductive factors,family history, occupation and risk of urogenital prolapse. Eur J Obstet Gynecol Reprod Biol 1999, 1:63-67.
- Swift SE, Pound T, Dias JK. Case-control study of etiologic factors in the development of severe pelvic organ prolapse. Int Urogynecol J 2001; 12: 187-92. PubMed
- Barber MD, Neubauer NL, Klein-Olarte V. Can we screen for pelvic organ prolapse without a physical examination in epidemiologic studies? Am J Obstet Gynecol 2006; 195: 942-8. PubMed
- Eva UF, Gun W, Preben K. Prevalence of urinary and fetal incontinence and symptoms of genital prolapse in women. Acta Obstet Gynecol Scand 2003; 82: 280-6. PubMed
- Lawrence JM, Lukacz ES, Nager CW, Hsu JW, Luber KM. Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women. Obstet Gynecol 2008; 111: 678-85. PubMed
- Handa VL, Cundiff G, Chang HH, Helzlsouer KJ. Female sexual function and pelvic floor disorders. Obstet Gynecol 2008; 111: 1045-52. PubMed
- Nygaard I, Handa VL, Brubaker L, et al.; for the Pelvic Floor Disorders Network. Changes in physical activity after abdominal sacrocolpopexy for advanced pelvic organ prolapse. Am J Obstet Gynecol 2008; 198: 570. PubMed
- Prolaps. Rapport nr 60 (2008) SFOG Arbets-och referensgrupp för urogynekologi och vaginal kirurgi.
- Haessler AL, Lin LL, Ho MH, Betson LH, Bhatia NN. Reevaluating occult incontinence. Curr Opin Obstet Gynecol 2005; 17: 535-40. PubMed
- Jha S, Toozs-Hobson P, Parsons M, Gull F. Does preoperative urodynamics change the management of prolapse? J Obstet Gynaecol 2008; 28: 320-2. PubMed
- Roovers JP, Oelke M. Clinical relevance of urodynamic investigation tests prior to surgical correction of genital prolapse: a literature review. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18: 455-60. PubMed
- Hagen S, Stark D, Maher C, Adams E. Conservative management of pelvic organ prolapse in women. Cochrane Database Syst Rev, issue 4, 2006. CD003882. Cochrane (DOI)
- Adams E, Thomson A, Maher C, Hagen S. Mechanical devices for pelvic organ prolapse in women. Cochrane Database Syst Rev, issue 2, 2004. CD004010. Cochrane (DOI)
- Handa VL, Garrett E, Hendrix S, Gold E, Robbins J. Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol 2004; 190: 27-32. PubMed
- Onwude JL. Genital prolapse i women. BMJ Clin Evid. 2012 Mar 14;2012. PMID: 22414610 PubMed
- Hagen S, Glazener C, McClurg D et al. Pelvic floor muscle training for secondary prevention of pelvic organ prolapse (PREVPROL): a multicentre randomised controlled trial. Lancet 2017; 389(10067): 393-402. pmid:28010994 PubMed
- Giri A, Hartmann KE, Hellwege JN et al. Obesity and pelvic organ prolapse: a systematic review and meta-analysis of observational studies. Am J Obstet Gynecol 2017 Jul(1);11-26. PMID: 28188775 PubMed
- Kudish BI, Iglesia CB, Sokol RJ et al. Effect of weight change on natural history of pelvic organ prolapse. Obstet Gynecol 2009 Jan; 113(1):81-8.II. PMID: 1910436 PubMed
- Stenstrom Bohlin K, Ankardal M, Nüssler E et al. Factors influencing the outcome of surgery for pelvic organ prolapse.Int Urogynecol J 2018; 29(1):81-89. PMID: 28894904 PubMed
- Maher C, Baessler K, Glazener CM, Adams EJ, Hagen S. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev, issue 3, 2007. CD004014. Cochrane (DOI)
- Altman D, Väyrynen T, Engh ME, et al. Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med 2011; 364: 1826-36. New England Journal of Medicine
- Sokol AI, Iglesia CB, Kudish BI, et al. One-year objective and functional outcomes of a randomized clinical trial of vaginal mesh for prolapse. Am J Obstet Gynecol 2012; 206: 86. PubMed
- Barbro Larson, docent och specialist i gynekologi och obstetrik, Stockholm
- Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet