Nu631U6peerdiscussionJenniferD

What is the diagnosis for her discomfort and pain?

The diagnosis for this patientâ€™s condition is a stage 2 pelvic organ prolapse and vaginal atrophy (Secor, 2023). This is based on her subjective assessment which included being post-menopausal, 4 vaginal deliveries, pain/dragging sensation in the lower abdomen/back while sitting/standing which is relieved when laying down. Urinary frequency, occasional incontinence, and chronic constipation that requires frequent digital assistance to push stool out. The objective findings that support the diagnosis include vulval anatomical changes that indicate vaginal atrophy. When the patient is supine, she has mild prolapse. Standing causes the cervix to fall where it can be felt/seen at the introitus level. Also, it shows large posterior wall prolapse and minimal anterior wall prolapse.

How would you manage this patient?

There are several treatment options we can consider when a patient presents with pelvic organ prolapse. They can include doing nothing if the symptoms are not severe or bothersome, conservative measures such as pelvic floor exercises or a pessary device all the way to surgical interventions (van der Vaart et al., 2022). This patient is 83 years old; she is healthy, and active. However, her symptoms have become painful, she is having urinary problems, and chronic constipation. I would suggest she try pelvic floor exercises to help strengthen the surrounding muscles, but this may not be effective at this stage. A pessary could be a valid option for the patient. This device is custom made to fit each person and is designed to hold the pelvic organs in place preventing pain, urinary, and bowel complications (van der Vaart, 2022). The device can cause discomfort if the pelvic muscles are too weak. She could be a candidate for surgical intervention, but the risks may outweigh the benefit at her age (van der Vaart et al., 2022).

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