Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Pelvic Organ ProlapseCystoceleRectoceleUterine prolapse ++ 618.01 Cystocele, midline618.02 Cystocele, lateral618.04 Rectocele618.1 Uterine prolapse without mention of vaginal wall prolapse618.2 Uterovaginal prolapse, incomplete618.3 Uterovaginal prolapse, complete618.4 Uterovaginal prolapse, unspecificed867.6 Injury to other specified pelvic organs, without mention of open wound into cavity ++ N81.10 Cystocele, unspecifiedN81.11 Cystocele, midlineN81.12 Cystocele, lateralN81.2 Incomplete uterovaginal prolapseN81.3 Complete uterovaginal prolapseN81.4 Uterovaginal prolapse, unspecifiedN81.6 Rectocele ++ Pattern 4C: impaired muscle performance1 +++ Description ++ 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 floorBladderUterusRectumMay or may not be accompanied byFeelings of pressure or painUrinary tract infectionUrinary incontinenceBladder obstructionBowel dysfunctionConstipationFecal incontinence +++ Essentials of Diagnosis ++ 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 +++ General Considerations ++ May be asymptomaticIf symptomatic, then symptoms are often non-specificSymptoms 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 presenceAny complaints or changes in bowel and bladder function should be investigated by a physicianDegree of prolapse does not correlate with severity of symptoms +++ Demographics2, 3 ++ Does not occur in menSome degree of prolpase may be seen in 50% of women in a clinical settingIn 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 prolapseHispanic women had the highest risk for uterine prolapseParity and obesity were strongly associated with increased risk for uterine prolapse, cystocele, and rectocele +++ Signs and Symptoms4 ++ Many have no symptomsMay see or feel a bulge in the vaginaSensation of protrusion or bulging62% of women with pelvic organ prolapse also have urinary stress incontinence5Obstructive bladder symptoms: difficulty initiating and completing urinationObstructive defecation symptoms: constipation +++ Functional Implications ++ Feelings of pressure during lifting6Obstructive bladder symptoms: difficulty initiating and completing urinationObstructive defecation symptoms: constipation +++ Possible Contributing Causes ++ PregnancyChildbirthLigamentous and connective tissue damagePubocervical fasciaArcus tendineus levator aniArcus tendineus fascia pelvisUnderactive, overactive, or non-functioning pelvic floor musclesObesitySystemic hypermobility ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.