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  • Pelvic Organ Prolapse
  • Cystocele
  • Rectocele
  • Uterine prolapse

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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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  • 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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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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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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  • Pregnancy
  • Childbirth
  • Ligamentous and connective tissue damage
    • Pubocervical fascia
    • Arcus tendineus levator ani
    • Arcus tendineus fascia pelvis
  • Underactive, overactive, or non-functioning pelvic floor muscles
  • Obesity
  • Systemic hypermobility

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Differential Diagnosis

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