Uterine prolapse, pelvic relaxation

Rationale

Pelvic relaxation is a common disorder which may impact physical well-being and social functioning. The symptoms associated with pelvic relaxation may be embarrassing, and may not be raised spontaneously. The physician should be familiar with, and screen for, the manifestations of pelvic relaxation.

Causal Conditions

(list not exhaustive)

This condition is usually multifactorial. Potential causal conditions include:

1. Damage to vagina and pelvic support system
   1. Vaginal birth
   2. Prior pelvic surgery
   3. Chronic increase in intra-abdominal pressure (e.g., chronic cough)
2. Neurogenic dysfunction of pelvic floor
3. Connective tissue disease
4. Genetic predisposition

Key Objectives

Given a patient with prolapse/pelvic floor relaxation, the candidate will diagnose the cause, severity, and complications, and will initiate an appropriate management plan.

Enabling Objectives

Given a patient with prolapse/pelvic floor relaxation, the candidate will

1. list and interpret critical findings, including
   1. the severity of symptoms, effect on activity, predisposing factors;
   2. the results of a physical examination aimed at determining the anatomical abnormality;
2. list and interpret critical investigations, including
   1. investigation for urinary tract infection;
3. conduct an effective initial management plan, including
   1. discussing benefits and limitations of treatment options (e.g., pelvic floor exercises, pessary, surgery) and strategies to slow progression;
   2. determining whether the patient needs to be referred for specialized care.