Long case

Personal history
Soad elamery , a 55 years old, housewife, lives in elsalam , para 4+0,with 4 living
offsprings , 2males and 2 females , married for 30 years from metwaly ahmed , 60
years, no special habits with medical importance. Positive consanguinity
Complaint
She presents with lower abdominal pain and low backache and fail to defacate
Present history
She presents with lower abdominal pain dragging and low backache when standing
or walking . it has been present from some years. But she can now only stand for a
short time before feeling comfortable. It is not noticeable at night . she has had 4
vaginal delivery .she had her menopause at 50 years and took hormone
replacement therapy for several years for vasomotor symptoms . she has not had
any postmenopausal bleeding and has not had smear for several years .she is
generally constipation and sometimes finds she can only defecate placing her
fingers into vagina and compressing a bulge she can feel . she has mild frequency
and gets up twice most nights to pass urine . there is no dur or heamaturia.
Occasionally she does not get to toilet in time and leaks a small amount of urine .
but this does not worry .medically she is very well and does not take any
medications regularly .
Obstetric history
All past\ previous 4 vaginal delivery , were in house , completed full term, no
intraoperative or postoperative complication.
Contraceptive history
She used contraceptive pills between every pregnancy with no complication
Menstrual history
She is menopause at 50 years
Past history
No history of previous operations, hospitalization, blood transfusion, allergy,
chronic illness such as liver or thyroid.
Family history
NO medical disorders or similar condition
Socioeconomic history
she lives alone in a home of 2 rooms with adequate air and water supply and
proper sewage disposal .
Examination
On examination , she appears well . BP and HR are normal .she is average fluid .
abdomen is soft and non tender . there is loss of vulval anatomy consistent with
atrophic changes . on examination in supine position there is a mild prolapse . on
standing , cervix is felt at level of introitous. There is large posterior wall prolapse
and minimal Anterior vaginal wall prolapse
Investigations

Provisional diagnosis
Soad elamery , 55 years old , para 4+0 , complain of lap and lb and fail to
defacate , no complicated.
management
initial management involves treating cons with dietary manipulation and laxatives .
this may relieve some of symptoms and also important to prevent recurrence if
surgery is to performed . pelvic floor exercise are helpful for mild prolapse and
preserve the integrity of repair postoperatively , though in this case they are
unlikely to make any significant difference to presenting symptoms. If surgery is
not wanted then she can try a ring pessary to hold up prolapse , which can work
extremely well and only need replacing every 6 months . vaginal hysterectomy
because old age