Pelvic organ prolapse: Difference between revisions
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==Background== | ==Background== | ||
* Herniation of pelvic organs to or beyond vaginal walls | * Herniation of pelvic organs to or beyond vaginal walls | ||
== | ===Risk Factors=== | ||
* Advancing Age | * Advancing Age | ||
* Multiparity | * Multiparity | ||
| Line 14: | Line 12: | ||
==Clinical Features== | ==Clinical Features== | ||
Severity may be related to position | |||
** 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> | ||
| Line 45: | Line 42: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
==== Cystocele ==== | ==== Cystocele ==== | ||
* Most common form of pelvic organ prolapse | * Most common form of pelvic organ prolapse | ||
| Line 62: | Line 58: | ||
==Evaluation== | ==Evaluation== | ||
*Clinical diagnosis | |||
==Management== | ==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 | * Expectant management | ||
* Conservative (vaginal pessary, pelvic floor muscle exercises) | * Conservative (vaginal pessary, pelvic floor muscle exercises) | ||
* Surgical | * Surgical | ||
==Disposition== | ==Disposition== | ||
Discharge with outpatient Gynecology referral | |||
==See Also== | ==See Also== | ||
*[[Rectal Prolapse]] | |||
[[Rectal Prolapse]] | |||
==References== | ==References== | ||
<references/> | <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 | |||
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 | |||
Revision as of 14:22, 19 June 2020
Background
- 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
- Avoidace of sexual activity due to fear of discomfort or embarassment
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