Pelvic organ prolapse: Difference between revisions
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* Multiparity | * Multiparity | ||
* Obesity | * Obesity | ||
* Race | * Race (Latina/white women at higher risk than black women) | ||
* [[Constipation]] | * [[Constipation]] | ||
* Connective | * [[Connective tissue disorder]]s | ||
* Chronic [[Cough]] | * Chronic [[Cough]] | ||
===Types=== | ===Types=== | ||
*Cystocele | *Cystocele | ||
** Most common form of pelvic organ prolapse | **Most common form of pelvic organ prolapse | ||
** Hernia of anterior vaginal wall + descent of bladder | **Hernia of anterior vaginal wall + descent of bladder | ||
*Rectocele | *Rectocele | ||
** Hernia of posterior vaginal segment + descent of rectum | **Hernia of posterior vaginal segment + descent of rectum | ||
*Enterocele | *Enterocele | ||
** Hernia of intestines to or through vaginal wall | **Hernia of intestines to or through vaginal wall | ||
*Uterine/ | *Uterine/vaginal vault prolapse | ||
** Descent of apex of vagina to lower vagina, hymen, or beyond introitus | **Descent of apex of vagina to lower vagina, hymen, or beyond introitus | ||
** Apex= uterus and cervix, cervix, or vaginal vault | **Apex= uterus and cervix, cervix, or vaginal vault | ||
** Apical prolapse often associated with enterocele | **Apical prolapse often associated with enterocele | ||
==Clinical Features== | ==Clinical Features== | ||
*Severity may be related to position | *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 | **Worse as day progresses, upright, and active | ||
*Vaginal | *Vaginal bulge/fullness, pressure | ||
*Urinary dysfunction | |||
*Urinary | |||
**Overactive bladder symptoms | **Overactive bladder symptoms | ||
**Urgency | **Urgency | ||
**Urinary incontinence | **[[Urinary incontinence]] | ||
**Enuresis<br> | **Enuresis<br> | ||
*Defecatory | *Defecatory dysfunction | ||
**[[Constipation]] | **[[Constipation]] | ||
**Incomplete emptying | **Incomplete emptying | ||
**Fecal urgency | **Fecal urgency | ||
**Fecal incontinence | **Fecal incontinence | ||
**Obstructive symptoms- | **Obstructive symptoms- straining or need for digital pressure to vagina in order to completely evacuate<br> | ||
*Sexual | *Sexual dysfunction | ||
**Reports of adverse effects or orgasm and sexual satisfaction | **Reports of adverse effects or orgasm and sexual satisfaction | ||
**Dyspareunia | **Dyspareunia | ||
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*Look for signs of infection or skin breakdown if prolonged prolapse | *Look for signs of infection or skin breakdown if prolonged prolapse | ||
*Reduction may be as simple as pushing organ back inside | *Reduction may be as simple as pushing organ back inside | ||
*If difficult reduction due to edema | *If difficult reduction due to edema: | ||
** Provide analgesia, and place copious granulated sugar | **Provide [[analgesia]], and place copious granulated sugar | ||
** Wait 15 minutes for edema to subside and re-attempt reduction | **Wait 15 minutes for edema to subside and re-attempt reduction | ||
** If reduction fails, consult | **If reduction fails, consult gynecology | ||
===Outpatient=== | ===Outpatient=== | ||
Treatment includes: | Treatment includes: | ||
* Expectant management | *Expectant management | ||
* Conservative (vaginal pessary, pelvic floor muscle exercises) | *Conservative (vaginal pessary, pelvic floor muscle exercises) | ||
* Surgical | *Surgical | ||
==Disposition== | ==Disposition== |
Revision as of 00:29, 22 October 2020
Background
- Definition: herniation of pelvic organs to or beyond vaginal walls
Risk Factors
- Advancing Age
- Multiparity
- Obesity
- Race (Latina/white women at higher risk than black women)
- Constipation
- Connective tissue disorders
- Chronic Cough
Types
- 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
Clinical Features
- Severity may be related to position
- Less noticeable in AM and supine
- Worse as day progresses, upright, and active
- Vaginal bulge/fullness, 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
Postmenopausal Pelvic Pain
Gynecologic
- Vulvovaginitis
- Atrophic vaginitis
- Infectious (STI)
- Allergic
- Uterine prolapse
- Cystocele
- Rectocele
- Enterocele
- Uterine/Vaginal Vault Prolapse
- Cervical polyps
- Uterine fibroids
- Endometrial hyperplasia
- Neoplasm
- Uterine
- Ovarian
Gastrointestinal
- Rectocele
- Diverticulitis
- Neoplasm
- Appendicitis
- Ischemic Bowel (Mesenteric Ischemia)
Urologic
- Infection
- Cystourethrocele
Prepubescent-Urethral prolapse
Urologic
- Sarcoma botryoides
Evaluation
- Clinical diagnosis
Management
Emergency Department
- 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