Examining Women’s Health
The given case study presents the examination of a woman with the feeling of fullness in her groin area. Among the key symptoms, it is possible to note general atrophic changes in genitalia, cystocele, as well as rectocele. At the same time, the physical examination reveals that when the patient stands in an upright position, her cervix comes down to the introitus, and the feeling of fullness becomes more perceptible. With the mentioned information in mind, it is possible to assume that the patient has pelvic organ prolapse, the aggravating factors, symptoms, and treatment options of which will be discussed in this paper.
The risk factors for the identified patient are her age and excessive intra-abdominal pressure. The latter might occur as a result of the increased rectal sphincter tone even though she has no vivid gastrointestinal health issues. The initial stages of pelvic organ prolapse may be asymptomatic and cause no painful sensations (Barber, 2016). When the pelvic organs fall out, there are pains and sensations of a foreign body in the vagina along with a constant feeling of pressure in the pubic area. Patients suffering from pelvic prolapse, including cystocele, rectocele, and so on, complain of a noticeable anatomical defect, urinary incontinence, and defecation problems such as constipation or incontinence (Barber, 2016). Also, they are concerned with aching pain and feeling of heaviness in the lower abdomen, violation of a sexual function, and vaginal discharge. Youngkin, Davis, Schadewald, and Juve (2013) state that further stages are characterized by pain extending to the lumbar region and sacrum, while the greatest problem is caused by the weakening of the ligamentous apparatus of the bladder and the disorders of urination that arise when the uterus descends.
The evidence shows that there are several types of pelvic organ prolapse, involving cystocele, rectocele, vaginal vault, uterovaginal, and cystourethrocele. Cystocele means the lowering of the anterior wall of the vagina, which is a predominantly common type of prolapse of pelvic organs in women (Youngkin et al., 2013). The most typical features of the above pathology are composed of frequent urination, difficulty during urinating, and feeling of incomplete emptying of the bladder. Rectocele, by analogy with cystocele, is associated with the posterior wall of the vagina and also known as apical vaginal prolapse (Youngkin et al., 2013). Constipation, difficulty in emptying the rectum, and foreign body sensation in the perineum characterize rectocele. Prolapse of the uterus is often combined with the omission of the bladder; thus, cystocele and rectocele may be diagnosed simultaneously. The vaginal vault develops only after the extirpation of the uterus for various pathologies. As for uterovaginal and cystourethrocele types of prolapse, they refer to the omission of the uterus and that of the urethra with bladder, respectively.
The imbalance of hormones playing a significant role in the regulation of metabolic processes in tissues can contribute to a greater disorder of genitalia and impede the treatment of pelvic prolapse. According to the recent research conducted by Weber et al. (2015), hypoestrogenic promotes a faster progression of dystrophic processes in supporting structures of pelvic bodies. The examination of urogenital atrophy expressed in the post-menopausal hormonal reductions and the onslaught of peri was used to determine the role of estrogens in preventing pelvic organ weakening (Giarenis & Robinson, 2014). The topical estrogen treatment proved to be more beneficial than the systemic medication administration due to a decrease in side effects and a lower dosage needed. Estrogen has the potential of enhancing the strength of the muscular, mucosal, and ligamentous elements of the pelvic organs.
The key method of treatment of pelvic organ prolapse is the operative removal of pelvic floor defects, and, in the presence of problems with urination and defecation, these disorders are eliminated during one surgical intervention. With the prolapse of the genitals, various vaginal and endoscopic techniques are actively used for the correction (Nygaard et al., 2013). For example, sacrocolpopexy is utilized in the case of cystocele and rectocele. In the case of urinary incontinence, the use of loop operations such as TVT, TVT-O, or IVS with the most advanced synthetic materials and their modifications is prescribed to eliminate the bladder sphincter incompetence.
The non-surgical treatment of pelvic organ prolapse refers to the general restorative treatment that is aimed at increasing the tone of tissues and eliminating the causes that contribute to the displacement of the genital organs (Dumoulin et al., 2016). Proper nutrition, water procedures, gymnastic exercises, and massage of the uterus are recommended. When selecting a method of treatment, not only the severity of prolapse but also the general condition of the patient should be considered (Dumoulin et al., 2016). The use of only conservative methods such as exercise therapy, electrical stimulation of the pelvic floor muscles, or wearing vaginal pessary rings is possible only at the early stages. The impossibility of conducting surgical treatment may be caused by severe concomitant diseases, pregnancy, recent childbirth, and other related reasons. Thus, it is possible to conclude that the non-surgical treatment seems to be useful for the given patient as her symptoms are not rather severe, and she has no urgent need to have surgery.
References
Barber, M. D. (2016). Pelvic organ prolapse. British Medical Journal, 354, 1-9. Web.
Dumoulin, C., Hunter, K. F., Moore, K., Bradley, C. S., Burgio, K. L., Hagen, S.,… Chambers, T. (2016). Conservative management for female urinary incontinence and pelvic organ prolapse review 2013: Summary of the 5th International Consultation on Incontinence. Neurourology and Urodynamics, 35(1), 15-20. Web.
Giarenis, I., & Robinson, D. (2014). Prevention and management of pelvic organ prolapse. F1000prime Reports, 6(77), 1-8. Web.
Nygaard, I., Brubaker, L., Zyczynski, H. M., Cundiff, G., Richter, H., Gantz, M.,… Warren, L. K. (2013). Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA, 309(19), 2016-2024. Web.
Weber, M. A., Kleijn, M. H., Langendam, M., Limpens, J., Heineman, M. J., & Roovers, J. P. (2015). Local oestrogen for pelvic floor disorders: A systematic review. PLoS One, 10(9), 1-26. Web.
Youngkin, E. Q., Davis, M. S., Schadewald, D. M., & Juve, C. (2013). Women’s health: A primary care clinical guide (4th ed.). New York, NY: Pearson.