Pelvic organ prolapse: Difference between revisions
| Line 15: | Line 15: | ||
** Less noticeable in AM and supine | ** Less noticeable in AM and supine | ||
** Worse as day progresses, upright, and active<br> | ** Worse as day progresses, upright, and active<br> | ||
*Vaginal Bulge/Fullness | |||
*Vaginal Pressure | |||
*Urinary Dysfunction | |||
**Overactive bladder symptoms | **Overactive bladder symptoms | ||
**Urgency | **Urgency | ||
**Urinary incontinence | **Urinary incontinence | ||
**Enuresis<br> | **Enuresis<br> | ||
*Defecatory Dysfunction | |||
**[[Constipation]] | |||
**Constipation | |||
**Incomplete emptying | **Incomplete emptying | ||
**Fecal urgency | **Fecal urgency | ||
**Fecal incontinence | **Fecal incontinence | ||
**Obstructive symptoms- Straining or need for digital pressure to vagina in order to completely evacuate<br> | **Obstructive symptoms- Straining or need for digital pressure to vagina in order to completely evacuate<br> | ||
*Sexual Dysfunction | |||
**Reports of adverse effects or orgasm and sexual satisfaction | **Reports of adverse effects or orgasm and sexual satisfaction | ||
**Dyspareunia | **Dyspareunia | ||
** | **Avoidance of sexual activity due to fear of discomfort or embarrassment | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 14:24, 19 June 2020
Background
- Definition: herniation of pelvic organs to or beyond vaginal walls
Risk Factors
- Advancing Age
- Multiparity
- Obesity
- Race: Latina + Caucasian Women higher risk than African American Women
- Constipation
- Connective Tissue Disorders
- Chronic Cough
Clinical Features
Severity may be related to position
- Less noticeable in AM and supine
- Worse as day progresses, upright, and active
- Vaginal Bulge/Fullness
- Vaginal Pressure
- Urinary Dysfunction
- Overactive bladder symptoms
- Urgency
- Urinary incontinence
- Enuresis
- Defecatory Dysfunction
- Constipation
- Incomplete emptying
- Fecal urgency
- Fecal incontinence
- Obstructive symptoms- Straining or need for digital pressure to vagina in order to completely evacuate
- Sexual Dysfunction
- Reports of adverse effects or orgasm and sexual satisfaction
- Dyspareunia
- Avoidance of sexual activity due to fear of discomfort or embarrassment
Differential Diagnosis
Cystocele
- Most common form of pelvic organ prolapse
- Hernia of anterior vaginal wall + descent of bladder
Rectocele
- Hernia of posterior vaginal segment + descent of rectum
Enterocele
- Hernia of intestines to or through vaginal wall
Uterine/Vaginal Vault Prolapse
- Descent of apex of vagina to lower vagina, hymen, or beyond introitus
- Apex= uterus and cervix, cervix, or vaginal vault
- Apical prolapse often associated with enterocele
Evaluation
- Clinical diagnosis
Management
Emergency Room
- Look for signs of infection or skin breakdown if prolonged prolapse
- Reduction may be as simple as pushing organ back inside
- If difficult reduction due to edema
- Provide analgesia, and place copious granulated sugar
- Wait 15 minutes for edema to subside and re-attempt reduction
- If reduction fails, consult Gynecology
Outpatient
Treatment includes:
- Expectant management
- Conservative (vaginal pessary, pelvic floor muscle exercises)
- Surgical
Disposition
Discharge with outpatient Gynecology referral
See Also
References
- Rogers, RG, Fashokun, TB. Pelvic organ prolapse in women: Epidemiology, risk factors, clinical manifestations, and management. In: Post T, ed. UpToDate; Waltham, MA.: UpToDate; 2020. www.uptodate.com. Accessed June 16, 2020