Symptoms of pelvic prolapse

Everyone has heard of prolapse of the uterus, ovaries or pelvic tissue, but no one has heard of pelvic prolapse. This is due to the falling of the pelvic tissue, which can cause a feeling of something flowing out, as well as varying degrees of back pain and a very obvious feeling of falling. This symptom will be alleviated after rest, but it will be more severe during urination.

Clinical manifestations

Patients with mild symptoms generally have no discomfort, while patients with severe symptoms may feel that there are masses coming out of the vagina, and have varying degrees of soreness or a feeling of falling in the lumbar sacral region. The symptoms are obvious after standing for too long or being tired, and are alleviated after resting in bed. They may also be accompanied by difficulty in defecation and urination. The long-term friction between the exposed cervix or vaginal wall and clothes can cause local ulcers and bleeding on the cervix or vaginal wall, and purulent secretions after secondary infection.

Uterine prolapse rarely affects menstruation, and may not even affect conception, pregnancy, and delivery. People with bulging of the anterior vaginal wall may have urination problems, such as a feeling of incomplete urination, urinary retention, urinary incontinence, etc. Sometimes they need to lift the anterior vaginal wall upwards to urinate. Bulging of the posterior vaginal wall may be accompanied by difficulty in defecation, and sometimes it is necessary to push the bulging posterior vaginal wall with fingers to expel feces.

Pelvic organ prolapse often occurs in multiple parts of the body at the same time. For example, uterine prolapse is often accompanied by bulging of the anterior and posterior vaginal walls, thickening and keratinization of the vaginal mucosa, and hypertrophy and elongation of the cervix. The anterior vaginal wall bulges in a spherical shape, the bulging bladder is soft, and the vaginal mucosal folds disappear. When the posterior wall of the vagina bulges, it is often accompanied by old perineal lacerations, and the rectum protruding into the vagina can be felt during digital rectal examination.

diagnosis

Pelvic organ prolapse is easily diagnosed based on history and physical examination. During the examination, the patient should be advised to hold his breath or apply abdominal pressure to determine the worst degree of prolapse and grade it, while paying attention to the presence of ulcers.

Differential Diagnosis

1. Urethral tumor

Female urethral tumors are often accompanied by urinary system symptoms, such as frequent urination, urgency, hematuria, etc., and there are often changes in the urine stream. Physical examination shows that the tumor is located in the urethra or around the urethral opening. The anterior wall of the vagina may bulge slightly backward due to the growth of the tumor, and the posterior wall of the vagina and the cervix are in normal positions. Urethroscopy and cystoscopy can determine the source of the tumor.

2. Vaginal wall tumor

It can occur in different locations of the vagina, manifesting as local bulges. The tumors are mostly solid and difficult to push or deform. Except for the location of the tumor, the other parts of the vaginal wall and cervix are normal.

3. Uterine inversion

It refers to a lesion in which the fundus of the uterus sinks into the uterine cavity or even turns out from the cervix. This is a rare but serious complication during delivery, most of which occurs in the third stage of labor.

4. Submucosal uterine fibroids

Mainly, submucosal fibroids that protrude outside the cervical opening or even the vaginal opening are easily confused with uterine prolapse. Patients with submucosal uterine fibroids often have a history of menorrhagia. The tumor is solid, red, and tough in texture. It has a pedicle connected to the uterine cavity, and the cervix can be felt around the pedicle.