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Cystocele, Rectocele, and Vaginal Prolapse - Essay Example

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Introduction and Etiology: All these three conditions are parts of a single disorder in the elderly women. This disorder is linked to loss of supports of the uterus and weakness of the pelvic floor. Cystocele is a condition characterized by hernia of the bladder trigone following weakness of the vaginal and pubocervical fascia…
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Cystocele, Rectocele, and Vaginal Prolapse
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Download file to see previous pages Vaginal prolapse on the other hand resembles a hernia for there is protrusion of part of the abdominal or pelvic contents through an aperture in the supporting structures. Protrusion takes place between the two levatores ani and, in more severe cases, through the orifice of the vagina when vaginal prolapse occurs (Hamilton-Fairley, D., 2004).
Signs and Symptoms: The commonest complaints are feeling of fullness of the vagina, a lump coming down, a dragging sensation or bearing down in the back or lower abdomen, vaginal discharge due to congestion of the cervix, an ulcer of the ectocervix or cervical ectropion, and a bloodstained discharge may occur if there is ulceration. Difficulty with coitus may be experienced if the cervix protrudes or is greatly elongated. Urinary symptoms include frequency of micturition. This is common and is often daytime only. Nocturnal frequency may be present if there is added cystitis. Some patients may have urgency of micturition due to weakness of the bladder sphincter mechanism and urge incontinence may occur in some cases. There may be difficulty in emptying the bladder completely and the woman may find she has to push the prolapse up with a finger to complete the act of micturition. Complete retention of urine may follow urethral overstretch. This may be associated with stress incontinence. Many women with prolapse complain of constipation, and this may be due to difficulty in emptying the rectum completely because it bulges into the vagina. Others notice discomfort on sitting on a firm surface; the vaginal wall over the rectocoele can bulge down between the labia. With age, the labia become atrophic and less protective and the prolapsed vagina is exposed to trauma when sitting on hard surfaces (Hamilton-Fairley, D., 2004).
A cystourethrocoele is usually obvious and the distance from the introitus to the bulge can be measured using a special ruler. The woman is asked to cough and any leakage of urine and/or descent of the cervix is noted. As the speculum is withdrawn any posterior vaginal wall prolapse can be noted. Where there is a complaint of stress incontinence, examination is best made with some urine in the bladder; the urethra and bladder neck may then be supported with two fingers to demonstrate that this maneuver controls the incontinence (Hamilton-Fairley, D., 2004).
Diagnostic and Therapeutic Procedures: Stress incontinence must be distinguished from other causes of incontinence of urine such as urge incontinence and incontinence due to neurological disease. General examination should include fitness for surgery. Abdominal examination should be performed to exclude an intra-abdominal mass. Manual pelvic examination or ultrasound should exclude a pelvic mass and delineate the size of the uterus and ovaries if present. If prolapse is not evident, even with a Valsalva manoeuvre, the patient should be examined in the upright position. It is important to reproduce the symptoms and signs with which the patient presents. If a woman has significant urinary symptoms, urodynamics may help define the cause of the symptoms, which will enable the gynaecologist to give some prognosis for treatment. Hence, if urodynamics ...Download file to see next pagesRead More
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