scholarly journals “I Felt Something Coming Down Below”: A Case of POP

Mumtaz Adiba Bt Juanda ◽  
Suzanna Daud

Pelvic floor disorders, which includes pelvic organ prolapse (POP), have shown an increasing prevalence among women worldwide. (Wu 2014) It is perceived as embarrassment and affect the women’s quality of life. A 68-year-old housewife, Para 3, complained of a 50-cent coin size lump coming down from her vagina since 2019, which could be reduced back manually inside the vagina. The symptom exacerbated by straining and carrying heavy objects. Ignoring the symptom, causing the lump to increase in size and protruded out from her vagina for the past 2 months. She had 3 SVD with maximum birth weight of 3.75kg and a prolonged second stage of labour in her second pregnancy. She was not aware and never practiced pelvic floor exercise nor taken any HRT. There were no urinary symptoms nor constipation. Her BMI is 25.2kg/m2. Abdominal examination was unremarkable. On speculum examination, vagina was atrophic and third degree uterine prolapse was evident. She was arranged to have Vaginal hysterectomy, anterior colporrhaphy and sacrospinous fixation done. The positive risk factors in this case are multiparity, menopausal status, a history of prolonged labor and frequent heavy lifting. The delay in presentation is due to lack of awareness. It was also found in a study that feeling of embarrassment and social stigma could be the reason. (Abhyankar 2019) Pelvic Floor exercise and avoidance of heavy lifting may be beneficial at onset of symptom. For conclusion, POP awareness is crucial to empower women to prevent POP and seek treatment as soon as they are symptomatic.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S24

Mochammad Andi Gunawan ◽  

Introduction: Uterine prolapse is the herniation of the uterus into or beyond the vagina as a result of failure of the ligamentous and fascial supports. It often coexist with prolapse of the vaginal walls, involving the bladder or rectum. A surgical treatment for uterine prolapse is hysterectomy. Changes in pelvic anatomic structure due to hysterectomy can result in impaired pelvic function because of nerve or pelvic muscle structure damage during surgery. Objective: This study aims to evaluate the presence of pelvic floor dysfunction in uterine prolapse patients who have undergone Total Vaginal Hysterectomy (TVH) surgery at Dr Sardjito General Hospital, from November 2018 to September 2019. Evaluations were carried out using Pelvic Floor Distress Inventory (PFDI) questionnaire. Methods: This study is an analytical descriptive research, using secondary data taken from patient’s medical records at Dr. Sardjito General Hospital Yogyakarta. It uses The Pelvic Floor Distress Inventory (PFDI) questionnaire, which consisted of 3 assessment groups, those are Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), Colorectal-Anal Distress Inventory 8m(CRADI 8), and Urinary Distress Inventory 6 (UDI- 6). The inclusion criteria of this study were patients with diagnoses of uterine prolapse, cystocele and rectocele, who could be contacted and gave consent to conduct telephone interview. Results: There were 14 patients that met the inclusion criteria, they are uterine prolapse, cystocele and rectocele patients with a history of TVH procedure, were assessed using PFDI questionnaire. All patients did not have any pelvic floor dysfunction either from the POPDI-6, CRADI-8 or UDI-6 assessment groups. The weakness of this evaluation is that the PFDI postoperative value cannot be compared with before surgery, so it cannot be proven that the absence of pelvic floor dysfunction in the patient concerned is a positive result of the surgery performed, or not give significant changes. Conclusion: There is no pelvic floor dysfunction in patients with a history of TVH procedure on the indication of uterine prolapse, which was performed at Dr Sardjito General Hospital Yogyakarta.

2021 ◽  
Vol 14 (5) ◽  
pp. e238669
Liam Joseph Beamer ◽  
Sarah Neary ◽  
Thomas McCormack ◽  
David Ankers

We describe the first reported case of transient distal ureteric obstruction attributed to post-surgical oedema in a patient with a solitary kidney. This occurred following combined pelvic floor repair and sacrospinous fixation for recurrent pelvic organ prolapse and manifested clinically as anuria, radiological hydroureter and acute kidney injury in the postoperative period. The transient nature of this obstruction, which was managed by a temporary percutaneous nephrostomy, indicates that it was caused by ureteric compression secondary to soft tissue oedema following surgery. We highlight the importance of this potential complication in females with a history of nephrectomy, unilateral renal tract anomalies or severely diminished renal reserve.

2014 ◽  
Vol 5 (3) ◽  
pp. 95-98 ◽  
Manidip Pal

Objective: To assess the effectiveness of pelvic floor exercise. Materials and methods: Hundred (100) patients of pelvic organ prolapse (POP), stress urinary incontinence (SUI) and overactive bladder (OAB) were included. They were advised pelvic floor exercise in stepwise incremental manner. Each time exercise comprised of 10 seconds holding up and 10 seconds relaxation. To start with it was 5 times each in the morning, noon, evening and night; making it 20 times per day. Every week 5 times increment. So by 5th week it was 25 times each in the morning, noon, evening and night; making it 100 times per day. After 6 months patients were assessed by their subjective feeling of improvement and clinical assessment. Results: After 6 months of therapy patients subjective feeling of improvement for POP, SUI and OAB were 73%, 84.1%, 58.3% respectively; though objective assessment did not show this much improvement. Conclusion: Pelvic floor exercise is an easy, effective and non-invasive tool that can be considered as first line therapy for these patients. Asian Journal of Medical Science, Volume-5(3) 2014: 95-98

2012 ◽  
Vol 26 (1) ◽  
pp. 2
Khaled Refaat ◽  
Constanze Fischer-Hammadeh ◽  
Mohamad Eid Hammadeh

Pelvic organ prolapse POP, including anterior and posterior vaginal prolapse, uterine prolapse, and enterocele, is a common group of clinical conditions affecting millions of women worldwide. The aim of this review is to highlight the clinical importance of prolapse, its pathophysiology, and different modalities for diagnosis and treatment. POP includes a range of disorders, from asymptomatic disturbed vaginal anatomy to complete vaginal eversion associated with considerable degrees of urinary, defecatory, and sexual dysfunction. The pathophysiology of prolapse is multifactorial however genetically susceptible women are more exposed to life events that result in the development of clinically significant prolapse. The evaluation of women with prolapse requires a comprehensive approach, with focusing on the function in all pelvic compartments based on a detailed patient history, physical examination, and investigations. Although prolapse is associated with many symptoms, few are specific for prolapse; it is often a challenge for the clinician to determine which symptoms are prolapse-specific and will therefore improve or resolve after prolapse treatment. Prolapse treatment is based on specific symptoms moreover its management options fall into two broad categories: nonsurgical, which includes pelvic floor muscle training and pessary use; and surgical, which can be reconstructive or obliterative. Associated symptoms require additional management. All women with prolapse can be treated and their symptoms improved, even if not completely resolved.

2014 ◽  
Vol 69 (2) ◽  
pp. e71-e77 ◽  
A.B. Rosenkrantz ◽  
M.T. Lewis ◽  
S. Yalamanchili ◽  
R.P. Lim ◽  
S. Wong ◽  

Budi I Santoso ◽  
Nur R Fauziah

Objective: To determine the prevalence and characteristics of pelvic floor dysfunction (PFD) in Jakarta, Indonesia. Methods: A cross sectional study was conducted at gynecology, endocrinology, and urogynecology clinic of Dr. Cipto Mangunkusumo Hospital during the period from January 2016 to April 2016. Subjects were selected using consecutive sampling. Data were taken using research and POP-Q form. Results: A total of 197 subjects were recruited. The prevalence of patients with PFD was 33%. The prevalence of POP, UI, and FI were 26.4%, 15.3% and 2.5%; respectively. Association between individual characteristics and PFD was found on women aged ≥ 60 and aged 40-59 years old with 69 and 14 times probability to be PFD. The probability of developing PFD was 76 and 14.2 times in multiparity and primiparity. Woman with vaginal delivery had a change to develop PFD 1.9 times and postmenopausal woman had a probability 18 times. The infuencing risk factor in PFD were age parity, race, mode of delivery, and menopausal status. Conclusion: Pelvic floor dysfunction affects a substantial of women and increases with age, parity and aging. [Indones J Obstet Gynecol 2017; 5-3: 168-172] Keywords: fecal incontinence, pelvic floor dysfunction, pelvic organ prolapse, urinary incontinence

Eny Lusiadewi

Objective: This study aimed to compare the expression of tenascin uterosacral ligament in women with and without pelvic organ prolapsen (POP). Methods: The research was carried out in Dr. Wahidin Sudirohusodo Hospital and other educational hospitals of obstetrics and gynecology division UNHAS Faculty of Medicine, which began on January 1st, 2011 until April 2012. This study assessed the expression of tenascin in 35 women with POP levels III and IV, and the controls were 35 women without POP. Tenascin expression was assessed by immunohistochemical examination using tenascin antibody staining (mouse monoclonal antibody Novacastra tenascin C, code NCL-Tenas C). The research was carried out cross sectional. Sampling was done by consecutive sampling. Data processed by the chi-square. The significance level used was 0.05. Results: The results showed that the characteristics of research subjects based on age, education, parity, labor history, history of big babies, not statistically significant. This indicates that the variable does not affect the calculation of the research data. While the characteristics of menopausal status and body mass index (BMI), from the analysis of risk factors for POP is associated significantly with a higher intensity of tenascin in post-menopausal status and BMI> 25 (overweight) (p

2018 ◽  
Nathan Kow

Pelvic organ prolapse (POP) is a common disorder that impacts a woman’s quality of life and has been projected to increase in the near future. Although many different treatments are currently available, healthcare practioners should be familiar with the common nonsurgical options that are considered the first-line therapy. Advances in nonsurgical interventions have traditionally included pessaries and pelvic floor muscle therapy.  These optiosn have not changed much over time, however there have been recent trials providing more evidence with regards to their efficacy.  The objective of this article is to review the current evidence for nonsurgical treatment options for POP.  This review contains 2 tables and 19 references Key Words: pelvic floor muscle training, pelvic floor physical therapy, pelvic organ prolapse, pessary, kegel excercises, uterine prolapse, cystocele, rectocele

Anupama Dave ◽  
Ruchi Joshi ◽  
Vibhu Goel ◽  
Atisha Dave

Background: MRI is the newest technique used to evaluate patients with pelvic floor disorders. It allows relatively non-invasive, dynamic evaluation of all pelvic organs in multiple planes and can directly visualize the muscular and ligamentous pelvic floor support structures. Using MRI to evaluate pelvic floor disorders may be most helpful in patients with multicompartment findings or symptoms, posterior compartment abnormalities, severe prolapse, or recurrent pelvic floor symptoms after prior surgical repair. MRI is often able to reveal more extensive organ prolapse than physical examination alone.Methods: The present study was carried out in the Department of Radiodiagnosis and Obstetrics and Gynecology of Mahatma Gandhi Memorial Medical College and M.Y. Hospital, Indore, Madhya Pradesh from November 2014 to October 2015. A total of 43 patients who had symptoms of pelvic floor dysfunction like uterine prolapse, urinary or rectal dysfunction were evaluated by high resolution USG. Patients with low lying uterus on USG were subjected to MRI. Before MRI, these patients were assessed by a Gynecologist, and a clinical diagnosis in form of the organ/organs prolapsed and the grade of individual prolapse was assigned and tabled in the prefixed format.Results: Prolapse is more common in patients with greater than 50 years age (63% patients). MRI picked up more lesions compared to clinical examination, 90% as compared to 82.5% on clinical examination. MRI has good correlation with surgery in diagnosing prolapse. Concomitant prolapse of the Anterior and Middle compartment is the most common clinical entity diagnosed on 52.5% patients in our set up. MRI has poor sensitivity in identifying posterior compartment prolapse. There is good agreement between the clinical grading and MRI grading (81.8% correlation).Conclusions: T MRI offers a novel approach of simultaneous imaging of all compartments of the female pelvis at a single setting. With lesser intraobserver variation and better visualization of the pelvic anatomy MRI would help in accurate staging and hence better outcomes in patients in terms of symptom relief.

2021 ◽  
pp. 55-57
Doss Prakash S ◽  
Sivan Aathira ◽  
Gupte Aditi ◽  
Tayade Amrapali

Pelvic organ prolapse is one of the common conditions in women with reproductive age group. In the developing countries pelvic organ prolapse poses as a common problem of the women population. We present a case of 21-year-old female with third degree uterine prolapse operated with laparoscopic sling procedure. The patient evaluation revealed weakness of pelvic oor muscles and urinary incontinence. She underwent threeweeks of structured and comprehensive Pelvic Floor Muscle Training (PFMT) in the department of Community Physiotherapy. The PFMT protocol included patient education primarily motivating the patient to adhere to the exercises. She was prescribed with relaxation technique, core muscle training and pelvic oor muscle strengthening exercises. There was a signicant improvement in the pelvic oor muscle strength after three weeks of therapy and there was a signicant improvement in the urinary incontinence. Presentation of this case clearly demonstrates the importance of pelvic oor muscle training in improving the strength of the pelvic oor muscles and controlling the urinary incontinence thereby improving quality of life

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