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A 75-year-old woman G5P5 presents for an annual exam and reports having a “fulln

A 75-year-old woman G5P5 presents for an annual exam and reports having a “fullness” in the vaginal area. The symptom is more noticeable when she is standing for a long period of time. She does not complain of urinary or fecal incontinence. She has no other urinary or gastrointestinal symptoms. There has been no vaginal bleeding. Her past medical history is significant for well-controlled hypertension and chronic bronchitis. She has never had surgery.
Pelvic exam reveals normal appearing external genitalia except for generalized atrophic changes. The vagina and cervix are without lesions. A cystocele and rectocele are noted. The cervix descends to the introitus with the patient in an upright position. Uterus is normal size. Right and left ovaries are not palpable. No rectal masses are noted. Rectal sphincter tone is slightly decreased. The patient prefers non-surgical treatment.
CC: “I feel fullness in my groin area”. Questions:
1. What increases this patient’s risk for pelvic organ prolapse?
2. What are the symptoms of pelvic organ prolapse?
3. What are the different types of pelvic organ prolapse?
4. What is the role of vaginal estrogen in patients with pelvic relaxation?
5. When is surgery indicated?
6. What are nonsurgical treatments?

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