CYSTOCELE

RECTOCELE

St.James’ College of Nursing, Chalakudy.

 CYSTOCELE

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St.James’ College of Nursing, Chalakudy.

DEFINITION

Also known as prolapsed bladder. Which

develops when the supportive tissue between a
woman’s bladder and vaginal wall weakens and
stretches ,allowing the bladder to bulge into the
vagina.

St.James’ College of Nursing, Chalakudy.

St.James’ College of Nursing, Chalakudy.
• It is associated with problems emptying the
bladder, urinary tract infections or
incontinence.

St.James’ College of Nursing, Chalakudy.

Causes
 Stress on the “hammock “during childbirth

 Frequent heavy lifting

 Chronic coughing

 Constipation

 Obesity

 Menopause(estrogen level start to drop)

 Previous pelvic surgery.

St.James’ College of Nursing, Chalakudy.

Symptoms
 Frequent urination or urge to urinate

 Stress incontinence

 Not feeling bladder relief immediately after urinating

 Frequent UTI

 Discomfort or pain in the vagina, pelvis, lowerabdomen, groin or lower

back

 Heaviness or pressure in the vaginal area

 Painful intercourse

 Tissue protruding from the vagina that may be tender and or bleeding
St.James’ College of Nursing, Chalakudy.
Investigation

 Pelvic examination

Voiding urethrogram

Urodynamics

Cystoscopy

Fluoroscopy

St.James’ College of Nursing, Chalakudy.

Treatment
Kegel exercise
Estrogen replacement therapy
Pessary
surgery

St.James’ College of Nursing, Chalakudy.

 RECTOCELE

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St.James’ College of Nursing, Chalakudy.

Rectocele
• Prolapse of the mucous membrane or the
entire rectum outside the anal verge.

St.James’ College of Nursing, Chalakudy.

Types
 Partial Prolapse
 Complete Prolapse

St.James’ College of Nursing, Chalakudy.

cause
• Common in multipara
• Repeated birth injuries to perineum results in
damage to the perineal nerve supply.
• Weakening of supporting tissue and levator
ani-muscle,
• Atony of sphincter
• Increased intra abdominal pressure due to any
cause like chronic cough

St.James’ College of Nursing, Chalakudy.

Partial prolapse
Here only mucosa and submucosa of the rectum
descends ,not more than 3.75cm.

St.James’ College of Nursing, Chalakudy.

St.James’ College of Nursing, Chalakudy.
Clinical features
History of mass per anum

It is pink in colour and circumferential

St.James’ College of Nursing, Chalakudy.

Complete prolapse

• Due to weakened levator ani and supporting

pelvic tissues
• The descend is always more than
3.75cm,contains all layers of the rectum

St.James’ College of Nursing, Chalakudy.

St.James’ College of Nursing, Chalakudy.
 Clinical features
• Which is red in colour and often painful ,as mass per anum.

• Faecal incontinence

• Bleeding can occur because of congestion

• Sepsis ,discharge, fever, anaemia

• P/R examination shows lax sphincter. Anteriorly, peritoneal

sac comes down as a pouch which may contain small bowel.

St.James’ College of Nursing, Chalakudy.

Investigation
Sigmoidoscopy
Anal manometry
Pudendal nerve latency study.

St.James’ College of Nursing, Chalakudy.

TREATMENT
• Pelvic floor exercise
• Avoid constipation –add more fiber in diet
• Avoid bearing down during bowel movement
• Avoid heavy lifting
• Control coughing
• Achieve and maintain a healthy weight

St.James’ College of Nursing, Chalakudy.

• Surgery
• Rectocele repair and colporrhaphy

St.James’ College of Nursing, Chalakudy.