Pelvic Vaginal examination of E.G. revealed 1st degree cystocele . Cystocele, otherwise known as a protrusion of the bladder, occurs when the bladder descends into the vagina. The bladder bulges through the anterior wall of the vagina, with which it is anatomically associated. Cystoceles result from a weakness of the pelvic-floor support system. The main associated risk factors are obesity, increasing age, and parity. They can also occur due to chronically increased intra-abdominal pressure, collagen abnormality, family history of cystocele, and following pelvic surgery. Complaints related to bladder prolapse may be divided into vaginal pressure, urinary symptoms, sexual dysfunction, and, rarely, defecatory symptoms. To aid history taking, a set of questions called the Pelvic Floor Impact Questionnaire (PFIQ) can be used to assess pelvic prolapse related symptoms. Prolapse consists of 4 stages; stage 0; no prolapse, stage 1; most distal part of prolapse is -1cm (above the level of the hymen), Stage 2 – most distal part of prolapse is >= -1cm but <= +1cm (<=1cm above or below the hymenal plane), Stage 3 – most outside portion of the prolapse >+1cm but <+(total vaginal length -2)cm (beyond the hymen; protrudes no farther than 2cm less than the total vaginal length), and Stage 4 – complete eversion of the vagina; most distal portion of the prolapse >= +(total vaginal length -2) cm. Perineal floor ultrasound scan is used to identify the evulsion of the perineal muscles from the symphysis pubis, which can increase the risk of cystocele development three to four times.
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