Pelvic Organ Prolapse
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Pelvic Inflammatory Disease see Pelvic Pain
Pelvic Organ Prolapse Pelvic organ prolapse
Figure 5. Examining the ovary and the pelvic wall with the examiner’s fingers. (Courtesy: Illustration drawn by Ginny Canady, Director of Audio/Video Resources, Department of Obstetrics/Gynecology, Medical University of South Carolina.)
is a condition denoting the descent of pelvic organs toward or through the vaginal opening. References to prolapse of the womb have first been made in ancient Egypt dating back to 1550 BC. Vaginal vault prolapse refers to significant descent of the vaginal apex (“the top of the vagina”) following a hysterectomy. Although obviously not a new condition, prolapse is becoming increasingly common due to increased life expectancy. Prolapse of the top of the vagina or uterus is rarely an isolated finding. The anterior vagina (front side or the bladder side of the vagina) and the posterior vagina (back or rectal side of the vagina) can and often do protrude independent of the uterus or the apex. Protrusion of the anterior vagina is also called a cystocele, while posterior vaginal prolapse is called a rectocele, named after the organs which are thought to descend along with the vagina, the bladder, and rectum. Prolapse of the vaginal apex can, but need not necessarily, be accompanied by an enterocele. Enterocele is defined as the presence of abdominal contents (such as small bowel or omentum) dissecting between the vagina and the adjacent rectum.
SYMPTOMS sitting position. The examiner should then talk with the fully clothed patient to discuss the findings of the examination and answer any questions that she may have. Thus the pelvic examination, which screens for cervical cancer and pelvic disease, has been completed. Giving the patient some time to collect her thoughts and to discuss the findings, we think, is the optimal way to complete this very important medical exam. SEE ALSO: Pap test, Pelvic examination, Pelvic pain
Suggested Resources The American College of Ob/Gyn. Patient education. www.acog.org Having a pelvic exam and pap test. www.cancer.gov/cancerinfo/ having-a-pelvic-exam
JAMES F. CARTER
Patients may present with an obvious vaginal bulge that is seen or felt by the woman. Conversely, she may complain of a vague sense of pelvic heaviness or a sensation as if “something is about to fall out.” Bulging is often noted to be worse toward the end of the day when compared to when she first awakes. When the vaginal lining remains exteriorized for a prolonged period of time, it undergoes thickening from the constant rubbing on undergarments. The vaginal tissue may develop sores (ulcers) and become infected. Urinary incontinence as well as difficulty voiding is common with pelvic organ prolapse and in severe cases complete urinary retention may be seen. Voiding difficulties may result in frequent urinary tract infections and, occasionally, overflow incontinence. Due to kinking of the urethra, urinary incontinence may be masked, in which case the woman does not think she has incontinence,
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