PROLAPSE

 Shobana,55yr

 Perimenopausal,P1L1

 Class 4 SEC

 Coir worker
Presenting Complaints
 Mass coming down per vagina-30yrs

 Discharge per vagina-2months

H/o Presenting Complaints
 Started 30 yrs back ,ie 6 mnths after
her delivery as a small mass about the
size of a gooseberry coming down per
vagina.
 Gradually increased ,now of the size of
an orange.
 Able to reduce the mass on her
own.Does not reduce on its own while
lying down
 Aggerevated on doing house hold work
& after having food.
 Assoc with discharge pv for the past 2
mnths.
 Not foul smelling ,white in colour,not
blood stained,present through out,not
assoc with pruritis vulvae.
 h/o frequency,nocturia ,urgency &
sense of incomplete evacuation.No
SUI.She has to reduce the mass in
order to pass urine.

 No h/o incontinence of flatus or

faeces.No need for splinting.

 h/o continuous low backache,relieved

on taking rest.

 No h/o bleeding pv,c/c

cough,constipation,use of pessary.
Menstrual h/o
 Menstruating for the past 42yrs

 Since 1 yr irregular cycles(once in 2

mnths)

 LMP-Jan 19
Marital/obstetric h/o
 Married at the age of 21
 P1 L1, FTNVD, birth weight not known
 Institutonal delivery,conducted by mid
wife
 h/o prolonged labour ,big caput
 Episiotomy not put,tear sutured later
 menses after 40 days of delivery.
 Breast fed for 3 yrs.
 Resumed work after 2 mnths of rest.
 Not aware of post natal exercise.
 Seperated from husband for past 22yrs
and is not having an active sexual life
ever since.
Past h/o
 Nil relevant

Family h/o
 Father expired due to old age
 Mother & 3 sisters-no h/o prolapse or
malignancy
Personal h/o
 Mixed diet
 Sleep ,appetite-normal
 Bowel habits-normal
 Frequency,urgency,nocturia,feeling of
incomplete evacuation of bladder.
Examination
 Moderatly built & nourished
 No pallor ,icterus,pedal edema,LNE
 Ht-158 cm , Wt-61 kg
 BMI-24.4
 PR-82/’ BP-120/84
 Spine & gait –N, No jt hypermobility.
 Breast-no mass, no discharge/nipple
 Thyroid-N
 Chest-no emphysematous change
normal vesicular breath sounds
 CVS-N
P/A
 Inspection
umbilicus central
All quadrants moving equally with
resp
No dilated veins/pulsations
No divarication of recti,striae+
No scar,hernial orifice normal.
palpation
 No mass,no free fluid.

L/E
 Mons &vulva –N
 Normal pubic hair
 No vulval erosion
 Urethra-N
 Introitus gaping with Cx lying outside
on straining.
 No SUI
 Cx –healthy,scanty white discharge
seen.No ulceration on the cervical lips
palpation
 Cystocoel is the leading
prolapse.urethrocoel +
 No rectocoel
 Cannot get above the swelling
 Levator ani tone+,perineal body intact
P/V
Ut RV n size mobile, ff
P/S
 Lateral vaginal sulcus seen
 Ant vaginal wall rugosity absent,
preserved posteriorly.
 Enterocoel not present.

 Supporting lateral vaginal wall with

sponge forceps-central defect
P/R
No rectocoel/enterocoel
Bidigital exmn-no rectovaginal facial
thinning
POP –Q
Aa Ba C
+3 +4 +5

GH PB TVL
5 2 8

Ap Bp D
-3 -2 8
SUMMARY
 55 yr old perimenopausal lady, P1 L1,a
coir worker from class 4 SEC,c/o
mass/vagina for the past 30 yrs
discharge p/v & back ache,with h/o a
prolonged and difficult labour,not
having an active sexual life.examination
suggestive of a stage 3
prolapse,anterior compartment defect -
cystocoel & urethrocoel,possibly central
along with apical defect.
DIAGNOSIS
 55 yr old P1 L1 perimenopausal lady
,coir worker by profession,not leading
an active sexual life,with a stage 3
prolapse, anterior compartment defect -
cystocoel & urethrocoel,possibly central
along with apical defect.