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A 63-year-old gravida IV, para II presents with a 2-year history of a sensation that something is "bulging" out of her vagina during straining. She is not emptying her bladder completely and often "double voids." She has no urinary incontinence. She has no gastrointestinal symptoms. Past gynecologic history is unremarkable apart from an abdominal hysterectomy and oophorectomy. The most likely diagnosis is
procidentia.
cystocele.
rectocele.
enterocele.
detrusor dyssynergia.
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but there is no urinary incontinence!
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A bladder that has dropped from its normal position may cause two kinds of problems: unwanted urine leakage and incomplete emptying of the bladder. The pubocervical fascia provides back support to the mid urethra, allowing compression when abdominal pressure is increased. This prevents urine loss with sudden increases in pressure, as with coughs, sneezes, laughs, or moves in any way that puts pressure on the bladder. If this compression is lost by tissue tears, then stress incontinence results.[1]
If the base of the bladder herniates, then urine will sump down into the inside of the hernia, and bladder emptying will be impaired.
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A cystocele is mild (grade 1) when the bladder droops only a short way into the vagina. With more severe (grade 2) cystocele, the bladder sinks far enough to reach the opening of the vagina. The most advanced (grade 3) cystocele occurs when the bladder bulges out through the opening of the vagina.[1]
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Symptoms
In mild cases, it's possible to not even notice any symptoms. When cystocele signs and symptoms do present themselves, they may include:
A feeling of fullness or pressure in your pelvis and vagina ” especially when standing for long periods of time.
Increased discomfort when you strain, cough, bear down or lift.
A bulge of tissue that, in severe cases, protrudes through your vaginal opening. The resulting soft bulge may feel like sitting on an egg, and often goes away when you lie down.
A feeling that you haven't completely emptied your bladder after urinating.
Loss of urinary control with coughing, laughing or sneezing (stress incontinence). In severe cases, you may not be able to control urination.
Recurrent bladder infections.
Pain or urinary leakage during sexual intercourse.So any of the symptoms are possible ,need to be only urinary incontinece.
thanks .
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hw do u diff cystocele from enterocele,,,i mean wht are the presenting symptoms.
thanks
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yes it is cystocele.coming out part is bldder herniation. she intially voids urine present in part which is not herniated. when herniation is releived she voids left urine.
