Women’s Health Brochure

Pelvic organ prolapse

The pelvic muscles and tissues support the pelvic organs like a hammock. The pelvic organs include the bladder, uterus and cervix, vagina, and rectum, which is part of the bowel. A prolapse happens when the pelvis muscles and tissues can no longer support these organs because the muscles and tissues are weak or damaged. This causes one or more pelvic organs to drop or press into or out of the vagina.

Pelvic organ prolapse is a type of pelvic floor disorder. The most common pelvic floor disorders are Urinary incontinence (leaking of urine), Fecal incontinence (leaking of stool), and Pelvic organ prolapse (weakening of the muscles and tissues supporting the organs in the pelvis). The different types of pelvic organ prolapse depend on the pelvic organ affected. The most common types include:

Dropped bladder (called cystocele). This is the most common type of pelvic organ prolapse. This happens when the bladder drops into or out of the vagina.

Rectocele. This happens when the rectum bulges into or out of the vagina. Dropped uterus (uterine prolapse). This happens when the uterus bulges into or out of the vagina. Uterine prolapse is sometimes associated with small bowel prolapse (called enterocele), where part of the small intestine, or small bowel, bulges into the vagina. Although it is rare, pelvic organ prolapse can also happen after a hysterectomy. Any part of the vaginal wall may drop, causing a bulge into or out of the vagina.

Pelvic organ prolapse happens when the muscles or connective tissues of the pelvis do not work as they should. The most common risk factors are Vaginal childbirth, which can stretch and strain the pelvic floor. Multiple vaginal childbirths raise the risk of pelvic organ prolapse later in life. However patients can get prolapse even if they have never had children or if they had a cesarean or C-section delivery. Long-term pressure on the abdomen, including pressure from obesity, chronic coughing, or straining often during bowel movements. Giving birth to a baby weighing more than 8½ pounds is also a risk factor.

Pelvic floor disorders are more common in older women. About 37% of women with pelvic floor disorders are 60 to 79 years of age, and about half are 80 or older. Loss of the female hormone estrogen during and after menopause can raise the risk of pelvic organ prolapse. Researchers are studying how genetics can play a role in pelvic organ prolapse.

The pressure from prolapse can cause a bulge in the vagina that can sometimes be felt or seen. Women with pelvic organ prolapse may feel uncomfortable pressure during physical activity or sex. Other symptoms of pelvic organ prolapse include Seeing or feeling a bulge or “something coming out” of the vagina, A feeling of pressure, discomfort, aching, or fullness in the pelvis, Pelvic pressure that gets worse with standing or coughing or as the day goes on, Leaking urine (incontinence) or problems having a bowel movement, Problems inserting tampons, Some women say that their symptoms are worse at certain times of the day, during physical activity, or after standing for a long time.

Diagnostic tests are based on symptoms, and the doctor will do a pelvic exam. The patient may be asked to strain or cough during the exam so the doctor can see whether these actions cause prolapse or urine leakage. The doctor may also do other tests to see whether the patient can completely empty the bladder when they go to the bathroom.

Treatment for pelvic organ prolapse depends on the type of prolapse, the symptoms, age, other health problems, and whether the patient is sexually active. Treatment may include one or more of the following: Pessary. A pessary is a removable device inserted into the vagina to support the pelvic organs. Pessaries come in many different shapes and sizes. Pessaries are often the first treatment the doctor will try. For pelvic floor muscle therapy, the doctor may show the patient how to do pelvic floor exercises or refer them to a physical therapist to do exercises to help strengthen the pelvic floor muscles. Pelvic floor muscle exercises can also help women who have pelvic organ prolapse as well as urinary incontinence Changing eating habits. If a patient has bowel problems, the doctor may recommend eating more foods with fiber. Fiber helps prevent constipation and straining during bowel movements.

Surgery to support the uterus or vagina. During surgery, the doctor may use the patient’s own body tissue or synthetic mesh to help repair the prolapse and build pelvic floor support. This type of surgery is recommended for sexually active women with serious prolapse of the vagina or uterus. Surgery to close the vagina. This surgery, called colpocleisis, treats prolapse by closing the vaginal opening. This can be a good option for women who do not plan to have or who no longer have vaginal intercourse.

A nursing care plan includes:

Splint abdomen to protect surgical site when moving and coughing. Limit activity: avoid lifting over five pounds for three months and refrain from sexual intercourse for six weeks. Monitor for signs and symptoms of infection, such as fever, pain, and drainage from the surgical site. Educate the patient on the importance of follow-up appointments. Follow a low-fiber diet to decrease bowel movements to allow time to heal. Take stool softeners as prescribed to avoid straining. Perform sitz baths to improve comfort.

References

Workman, C.R.D.I.M. L. Medical-Surgical Nursing. [Bookshelf Ambassadored]. Retrieved from https://ambassadored.vitalsource.com/#/books/9780323461580/

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Question

Women’s Health Brochure

Module 01 Content

Top of Form

Competency

Identify multidimensional nursing care strategies for clients with reproductive system disorders.

Scenario

You work in a gynecological office, and your office has been asked to participate in a women’s health fair. The focus of the fair is health promotion. Preventative screening for female reproductive disorders is vital to identify and treat rapidly to produce the best patient outcomes. Preventative screening includes a mammogram and Pap smear and should be performed based on recommended age and associated risk factors. To promote preventative screening, your office will be creating brochures to distribute at the health fair.