Cystocele and Rectocele

Question 1

what kind of women commonly get hernias?

Answer 1

multiparous

Question 2

cystocele

Answer 2

hernia of the bladder wall into the vag- causes a soft anterior fullness

+/- urethrocele–> not a hernia, but a sagging of the urethra following its detachment from the pubic symphysis during childbirth

Question 3

rectocele

Answer 3

hernationof the terminal recturm into the posterior vag, causing a collapsible pouch-like fullness

Question 4

what is the classification system of these?

Answer 4

Baden-Walker Sys: standardizes the degree of descent of the anterior vaginal wall, cervix, or vaginal apex, and the posteriro vag wall
- have pt perform the valsalva maneuver while in the lithotomy position

Question 5

what are the clinical features of a pelvic organ prolapse?

Answer 5

sensation of a bulge or protursion, urinary or fecal incontinence, sense of incomplete bladder empyting and dyspareunia

Question 6

tx of cystocele and rectocele?

Answer 6

depends on the extent of the prolapse and the pts age/desire for menstruation, prgeo or colitis

Question 7

general tx

Answer 7

supportive:

• high fiber diet and laxatiives
• weight reduction in obese pts and limiation of straining/lifting
• Kegel
• Pessaries

Question 8

surgical tx

Answer 8

only cure is corrective surgery

• most common is vaginal or abdominal hysterectomy w.. vaginal vault suspension by ethier uteroscacral or sacrospinous fixation vaginally or abdominal sacral colpopexy
• also, anit-incontinence procedure, uterine suspension