STUDENT PROBLEM-BASED LEARNING SESSION
Pelvic Organ Prolapse and Urinary Incontinence
A 75-year-old woman G 5 P 5 presents for an annual exam and reports having a “fullness” in the vaginal area. The symptom is more noticeable when she is standing for a long period of time. She does not complain of urinary or fecal incontinence. She has no other urinary or gastrointestinal symptoms. There has been no vaginal bleeding. Her past medical history is significant for well-controlled hypertension and chronic bronchitis. She has never had surgery.
Pelvic exam reveals normal appearing external genitalia except for generalized atrophic changes. The vagina and cervix are without lesions. A cystocele and rectocele are noted. The cervix descends to the introitus with the patient in an upright position. Uterus is normal size. Right and left ovaries are not palpable. No rectal masses are noted. Rectal sphincter tone is slightly decreased. The patient prefers non-surgical treatment. A pessary is placed and you prescribe vaginal estrogen to address atrophic changes.
Patients with conditions of pelvic organ prolapse and urinary incontinence present in a variety of ways. The physician should be familiar with the types of pelvic organ prolapse and incontinence, and the approach to management of these patients.
The APGO Educational Objectives related to this topic are the following:
*Designated as Priority One in the APGO Medical Student Educational Objectives, 8 th Edition