I. Definition

  1. Pelvic organs (Bladder, Uterus, vagina) protrudes out of vaginal canal
  2. Pelvic Organ Prolapse replaces older terms (Cystocele, Uterocele, Rectocele)
    1. Reflects uncertainty on examination of which organs are actually prolapsing

II. Pathophysiology

  1. Levator ani muscle
    1. Normally supports the vagina from prolapse in the face of increased intraabdominal pressure
    2. When levator ani loses tone, allows pelvic organs to prolapse
  2. Other factors
    1. Connective tissue weakening
    2. Pudendal nerve injury from child birth

III. Grading: Braden-Walker System

  1. Evaluate when patient performing valsalva or straining
  2. Grade 0: No prolapse
  3. Grade 1: Descent halfway to hymen
  4. Grade 2: Descent to the hymen
  5. Grade 3: Descent halfway passed the hymen
  6. Grade 4: Maximal possible descent

IV. Grading: Older system

  1. First-degree: On pressing on perineum, Cervix visible
  2. Second-degree: Cervix protrudes via vaginal introitus
  3. Third-degree: Entire Uterus is external to introitus

V. Symptoms

  1. Peristent pelvic pressure provoked by straining
  2. Patient notes protruding tissue from introitus
  3. Spotting or bleeding per vagina

VI. Signs

  1. Uterine Prolapse on provocative maneuvers
    1. Valsalva
    2. Standing

VII. Risk Factors

  1. Decreased support of pelvic organs
    1. Multiparous women
      1. Vaginal deliveries
      2. Prolonged labor, instrumented delivery, episiotomy
    2. Advanced age (esp. Menopause)
    3. Prior hysterecyomy
  2. Increased intraabdominal pressures
    1. Overweight
    2. Constipation
    3. Heavy lifting
    4. Ascites
  3. Nerve disorders (especially affecting pudendal nerve)
    1. Spina Bifida Occulta

VIII. Managment

  1. General Measures
    1. Treat Constipation
    2. Weight loss in Obesity
  2. Mechanical Support
    1. Kegal Exercises
    2. Pessary
  3. Medications
    1. Consider Estrogen Replacement Therapy
  4. Surgery
    1. Hysterectomy
    2. Trasvaginal sacrospinous fixation
    3. Colpocleisis
      1. Obliterative surgery for high risk patients with multiple comorbidity

Images: Related links to external sites (from Google)

Ontology: Rectocele (C0149771)

Definition (MSH) A hernial protrusion of part of the rectum into the vagina. (Dorland, 28th ed)
Concepts Acquired Abnormality (T020) , Disease or Syndrome(T047)
MSH D020047
ICD9 618.04
ICD10 N81.6
SnomedCT 447072005, 62730001, 155991000, 266658002
English Rectocele, Hernia, rectovaginal, RECTOCELE, RECTOVAGINAL HERNIA, Proctocele, Proctocele, NOS, Rectocele, NOS, Rectocoele, rectocele, vaginal rectocele, rectocele (diagnosis), rectocele (physical finding), Proctoceles, Rectoceles, Rectocele [Disease/Finding], rectoceles, proctocele, Herniation of rectum into vagina, Rectovaginal prolapse, Herniation of rectum into vagina (disorder), Rectovaginal hernia, hernia; rectovaginal, rectovaginal; hernia, rectocoele
Swedish Ändtarmsbråck
Japanese チョクチョウリュウ, 経腟直腸脱, 直腸瘤, 直腸脱-経腟, 直腸脱-腟内, 腟内直腸脱
Czech výhřez konečníku, rektokéla, Rektokéla
Spanish Rectocele, herniación de recto en vagina, prolapso rectovaginal, herniación de recto en vagina (trastorno), hernia rectovaginal, proctocele, rectocele (trastorno), rectocele
Finnish Rektoseele
Russian REKTOTSELE, РЕКТОЦЕЛЕ
Italian Proctocele, Rettocele
Korean 직장류
Polish Przepuklina odbytnicy
Hungarian Rectocele
Dutch hernia; rectovaginaal, rectovaginaal; hernia, Rectoklel, rectokèle, Rectocele, Rectokèle
Portuguese Rectocelo, Retocele
French Rectocèle, Proctocèle
German Rektozele

Ontology: Prolapse of female genital organs (C0156349)

Concepts Disease or Syndrome (T047)
ICD9 618
SnomedCT 155995009, 155989008, 198283007, 73998008
English Genital prolapse, NOS, PROLAPSE OF THE FEMALE GENITAL ORGANS, Prolapse of female genital organs, NOS, Genital prolapse NOS, genital prolapse, genital prolapse (diagnosis), 7-73 PROLAPSE OF THE FEMALE GENITAL ORGANS, Genital prolapse NOS (disorder), Genital prolapse (disorder), prolapse genital, Genital prolapse, Prolapse of female genital organs (disorder), genital; prolapse, prolapse; genital, Prolapse of female genital organs
Italian Prolasso genitale, Prolasso genitale NAS
Dutch geslachtsorgaanprolaps NAO, genitaal; prolaps, prolaps; genitaal, genitale prolaps
French Prolapsus génital SAI, Prolapsus génital
German Prolaps der Geschlechtsorgane NNB, Prolaps der Geschlechtsorgane
Portuguese Prolapso genital NE, Prolapso genital
Spanish Prolapso genital NEOM, Genital prolapse, Genital prolapse NOS, prolapso de los órganos genitales femeninos (trastorno), prolapso de los órganos genitales femeninos, prolapso genital, SAI (trastorno), prolapso genital, SAI, prolapso genital, Prolapso genital
Japanese 性器脱, 性器脱NOS, セイキダツ, セイキダツNOS
Czech Prolaps pohlavních orgánů NOS, Prolaps pohlavních orgánů
Hungarian Genitalis prolapsus k.m.n., Genitalis prolapsus

Ontology: Cystocele (female) (C1394494)

Concepts Disease or Syndrome (T047)
ICD10 N81.1 , N81.10
English Cystocele, Bladder cystocele, cystocele (physical finding), vaginal cystocele, fallen bladder, cystocele, cystocele (diagnosis), Cystocele, unspecified, Cystocele (female), cystocele; female
German Zystozele
Korean 방광류
Dutch cystokèle; vrouw, Cystoklel