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cystocele is a structural problem of the genitourinary (GU) tract that occurs in women. The urinary bladder presses against a weakened anterior vaginal wall, thus causing the bladder to protrude into the vagina. The weakened vaginal wall is unable to support the weight of urine in the bladder, and this results in incomplete emptying of the bladder and cystitis.

A rectocele is a defect in the rectovaginal septum causing a protrusion of the rectum through the posterior vaginal wall. The rectum presses against a weakened posterior vaginal wall, thus causing the rectal wall to bulge into the vagina. The pressure against the weakened wall is intensified each time the woman strains to have a bowel movement; feces push up against the vaginal wall and intensify the protrusion. Frequently a rectocele is associated with an enterocele, a her-niation of the intestine through the cul-de-sac.

The primary cause of cystoceles and rectoceles is a weakened vaginal wall. Factors that contribute to this loss of pelvic muscle tone are repeated pregnancies, especially those spaced close together, congenital weaknesses, and unrepaired childbirth lacerations. Obesity, advanced age, chronic cough, constipation, forceps deliveries, and occupations that involve much standing and lifting are also contributing factors. Lack of estrogen after menopause frequently aggravates the condition.

The disorders tend to occur in middle-aged and elderly women who have had children, and incidence increases with age and parity. Ethnicity and race have no known effects on the risk for cystocele.

HISTORY. Patients with a cystocele often have a history of frequent and urgent urination, frequent urinary tract infections, difficulty emptying the bladder, and stress. Ask about the pattern and extent of incontinence: Does incontinence occur during times of stress, such as laughing and sneezing? Is it a constant, slow seepage? Is the amount such that the patient needs to use a peri-pad or adult diaper?

Patients with a rectocele have a history of constipation, hemorrhoids, pressure sensations, low back pain, difficulty with intravaginal intercourse, and difficulty controlling and evacuating the bowel. Symptoms may be worse when standing and lifting and are relieved somewhat when lying down. Obstetric history often reveals a forceps delivery. Some report that they are able to

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Constipation Prescription

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