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1. What is the diagnosis for her discomfort and pain?

The most likely diagnosis for the patient’s pain and discomfort is pelvic organ prolapse. Particularly, uterine prolapse is suggested by cervix examination results at the level of introitus on standing (Collins & Lewicky-Gaupp, 2022). In contrast, a rectocele is compatible with a substantial posterior vaginal wall prolapse, while a cystocele is consistent with a modest anterior vaginal wall prolapse. The breakdown of connective tissue and the pelvic floor muscles results in pelvic organ prolapse. At the base of the abdominopelvic cavity are the muscles of the pelvic floor (Carcio & Holland, 2023).

2. How would you manage this patient?

Concerning management, the clinician will need to carry out a further evaluation of this client. To rule out urinary tract infections, a clean midstream urine sample must be obtained. BUN and creatinine can be collected to evaluate renal function. To characterize the degree of loss of support structures, the clinician may request an MRI or ultrasound. Because of her ongoing constipation, this patient will also benefit from proctosigmoidoscopy and proctography. Investigating urine leakage also requires urodynamic testing (Raju & Linder, 2021). In the event that the patient has never had a cervical cancer screening, cervical cytology should also be performed.

Depending on the patient’s preferences, pelvic organ prolapse can be treated either conservatively or surgically. Before performing surgery, the patient’s age should also be taken into consideration. Vaginal support devices and workouts targeting the pelvic muscles will be part of this patient’s care. Exercises for the pelvic floor muscles will resolve urine leaks and enhance pelvic floor muscular tone. Nevertheless, according to Bugge et al. (2020), this technique has no effect on pelvic muscle prolapse. The majority of urogynecologists treat pelvic organ prolapse with vaginal support devices initially. In patients with stage 2 prolapse, like the one in this instance, ring pessaries are 100% successful (Bugge et al., 2020). The patient should apply topical estrogen prior to pessary use, given the indications of atrophic vaginitis, and then once or twice a week once the ring is in place (Bugge et al., 2020). It’s also crucial to teach patients how to take off and fit the ring. Finally, the physician needs to check on the patient for vaginal erosion and look into any vaginal bleeding that may go undetected (Bugge et al., 2020).

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