Clinical manifestations, diagnosis, and nonsurgical management of posterior vaginal defects
- Amy J Park, MD
Amy J Park, MD
- Assistant Professor
- Departments of Obstetrics & Gynecology and Urology
- Georgetown University
- Tristi W Muir, MD
Tristi W Muir, MD
- Department of Obstetrics and Gynecology
- Houston Methodist Hospital
- Marie Fidela R Paraiso, MD, FACOG
Marie Fidela R Paraiso, MD, FACOG
- Professor of Surgery
- Director, Urogynecology and Reconstructive Pelvic Surgery
- Cleveland Clinic Lerner College of Medicine at Case Western University
Pelvic organ prolapse (POP) includes defects of the anterior, apical, and posterior vaginal wall. Defects of pelvic support often do not occur in isolation. As an example, one series of 384 women undergoing surgical repair of POP reported the following types and frequencies of defects: anterior compartment only (40 percent), posterior compartment only (7 percent), apex only (6 percent), anterior and posterior compartments (16 percent), anterior compartment and apex (9 percent), posterior compartment and apex (5 percent), and all three compartments (18 percent) .
Posterior vaginal defects may be associated with:
●Rectocele (anterior protrusion of the rectum)
●Sigmoidocele (protrusion of the sigmoid colon)
●Enterocele (protrusion of the small bowel)
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- RISK FACTORS
- Vaginal childbirth
- Pelvic surgery
- Elevated intra-abdominal pressure
- Collagen abnormality
- Advancing age
- Increasing body mass index
- CLINICAL MANIFESTATIONS
- Physical examination
- - Pelvic examination
- - Focused neurologic examination
- - Assessment of anal sphincter
- - Assessment of urinary incontinence
- - Defecography
- - Contrast studies of bowel
- - Magnetic resonance imaging
- Ancillary testing
- Treatment of bowel symptoms
- Expectant management
- Pelvic floor muscle training
- SUMMARY AND RECOMMENDATIONS