Learning Objectives #
1. To be able to examine and diagnose a cystocele and rectocele
Introduction #
To evaluate the pelvic organ prolapsed, gently separate the labia widely and depress the perineum. Ask the patient to bear down or cough. If vaginal relaxation is present, ballooning of the anterior or posterior walls may be seen. Bulging of the anterior wall is associated with a cystocele, bulging of the posterior wall indicates a rectocele. If stress incontinence is present, the coughing or bearing down may trigger a spurt of urine from the urethral orifice.
To confirm the initial findings the univalve speculum is placed posteriorly to retract the posterior wall downward when examining the anterior compartment and the patient is encouraged to perform the Valsalva so the full extent of the prolapse can be ascertained. The speculum is then placed anteriorly to retract the anterior wall upward when examining the posterior compartment.
If the findings determined with Valsalva are inconsistent with the patient’s description of her symptoms, it may be helpful to perform a standing straining examination with the bladder empty.