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Condition/Disorder Synonyms

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  • Pelvic Organ Prolapse

  • Cystocele

  • 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 prolapse without mention of vaginal wall prolapse

  • 618.2 Uterovaginal prolapse, incomplete

  • 618.3 Uterovaginal prolapse, complete

  • 618.4 Uterovaginal prolapse, unspecificed

  • 867.6 Injury to other specified pelvic organs, without mention of open wound into cavity

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ICD-10-CM Codes

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  • N81.10 Cystocele, unspecified

  • N81.11 Cystocele, midline

  • N81.12 Cystocele, lateral

  • N81.2 Incomplete uterovaginal prolapse

  • N81.3 Complete uterovaginal prolapse

  • N81.4 Uterovaginal prolapse, unspecified

  • N81.6 Rectocele

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Preferred Practice Pattern

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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 of 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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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 non-specific

  • 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 it's 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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Signs and Symptoms4

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  • Many have no symptoms

  • May see or feel a bulge in the vagina

  • Sensation of protrusion or bulging

  • 62% of women with pelvic organ prolapse also have urinary stress incontinence5

  • Obstructive bladder symptoms: difficulty initiating and completing urination

  • Obstructive defecation symptoms: constipation

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Functional Implications

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  • Feelings of pressure during lifting6

  • Obstructive bladder symptoms: difficulty initiating and completing urination

  • Obstructive defecation symptoms: constipation

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Possible Contributing Causes

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