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CONDITION/DISORDER SYNONYMS

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  • Cystocele

  • Pelvic organ prolapse

  • Rectocele

  • Uterine prolapse

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ICD-9-CM CODES

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  • 618.01 Cystocele midline

  • 618.02 Cystocele lateral

  • 618.04 Rectocele

  • 618.1 Uterine prolapsed

  • 618.2 Uterovaginal prolapse incomplete

  • 618.3 Uterovaginal prolapse complete

  • 618.4 Uterovaginal prolapse unspecified

  • 867.6 Pelvic organ injury

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ICD-10-CM CODES

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  • N81.10 Cystocele unspecified

  • N81.11 Cystocele midline

  • N81.12 Cystocele lateral

  • N81.6 Rectocele

  • N81.2 Incomplete uterovaginal prolapse

  • N81.3 Complete uterovaginal prolapsed

  • N81.4 Uterovaginal prolapsed unspecified

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PREFERRED PRACTICE PATTERN

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  • 4C: Impaired Muscle Performance1

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PATIENT PRESENTATION

A 68-year-old female was cleaning her rental apartment after the renters had moved out. She was moving furniture and lifting boxes. Later that day, after urinating and while wiping, she felt something bulging into her vagina. When she stood up, she noticed a feeling of pressure in her vagina.

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KEY FEATURES

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Description
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  • Abnormal descent or herniation of pelvic organ from normal attachment sites in the pelvis secondary to damage to connective tissue support structures and/or weakening or muscles of the pelvic floor

    • Bladder

    • Uterus

    • Rectum

  • May or may not be accompanied by

    • Feelings of pressure or pain

    • Urinary tract infection

    • Urinary incontinence

    • Bladder obstruction

    • Bowel dysfunction

    • Constipation

    • Fecal incontinence

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FIGURE 276-1

Prolapse of the uterus. (Reproduced with permission from, DeCherney AH, Pernoll ML eds. Current Obstetrics & Gynecology Diagnosis & Treatment. 8th ed. Originally published by Appleton & Lange. Copyright ©1994 by The McGraw-Hill Companies, Inc.)

Graphic Jump Location
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Essentials of Diagnosis
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  • Physical examination with or without a speculum for palpation and visualization of the position of the pelvic organs relative to the anterior and posterior vaginal walls

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General Considerations
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  • May be asymptomatic.

  • If symptomatic, then symptoms are often nonspecific.

  • Symptoms of pressure in the vagina and rectum, self palpation of a mass in the vagina, or visualization of the prolapse may be the first indication to the patient of its presence.

  • Any complaints or changes in bowel and bladder function should be investigated by a physician.

  • Degree of prolapse does not correlate with severity of symptoms.

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Demographics2,3
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  • Does not occur in men.

  • Some degree of prolpase may be seen in 50% of women in a clinical setting.

    • In women with a uterus, the rate of uterine prolapse was 14.2%; the rate of cystocele was 34.3%; and the rate of rectocele was 18.6%.

    • For women who have undergone hysterectomy, the prevalence of cystocele was 32.9% and of rectocele was 18.3%.

  • African American women demonstrated the lowest risk for prolapse.

  • Hispanic women had the highest risk for uterine prolapse.

  • Parity and obesity were strongly associated with increased risk for uterine prolapse, cystocele, and rectocele.

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CLINICAL FINDINGS

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