Monday, August 3, 2009

Falling Out of Place

A 70 year old G4P4 (all vaginal deliveries) presents with a sensation of pelvic heaviness. "It's like I'm sitting on an egg," she says. She also has some low back pain. Her symptoms worsen during the day and with long periods of physical exertion; lying down makes them better. She's noticed some urinary stress incontinence as well. She has obesity, COPD, and chronic cough. Review of systems is positive for constipation.

Challenge: What's your most likely diagnosis?

Image is in the public domain.

3 comments:

Anonymous said...

uterine prolapse

Alex said...

rectocele?

Craig Chen said...

yep
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Falling Out of Place

This is pelvic organ prolapse, hernia of the uterus (uterine prolapse), vaginal apex (vaginal vault prolapse), bladder (cystocele, cystourethrocele), or rectum (rectocele, enterocele) from its normal location, graded from 0-4.

Sources: UpToDate; Wikipedia.