Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with complaints of pelvic pressure, a sensation of "falling out," or a visible/palpable bulge at the vaginal introitus. Symptoms are exacerbated by prolonged standing, physical exertion, or Valsalva maneuver, and often improve with recumbency. Associated symptoms include urinary frequency, urgency, incomplete bladder emptying, or the need for digital splinting to facilitate defecation.
Clinical Examination Findings
Pelvic examination performed in lithotomy position. POP-Q staging utilized: Cystocele noted with anterior vaginal wall descent [Stage 0-IV]. Rectocele noted with posterior vaginal wall descent [Stage 0-IV]. Evaluation of vaginal mucosa reveals [intact/atrophic/ulcerated]. Assessment of pelvic floor muscle strength [0-5 scale] and presence of apical support/uterine prolapse.
Treatment Protocol
Conservative management options discussed: Pelvic floor physical therapy (Kegel exercises), lifestyle modifications (weight loss, smoking cessation, avoidance of heavy lifting), and pessary fitting for mechanical support. Surgical intervention (e.g., anterior/posterior colporrhaphy, mesh-augmented repair, or sacrocolpopexy) discussed as definitive treatment for symptomatic high-grade prolapse.