Journal of Medical Sciences and Health

Introduction

Uterine prolapse is a condition in which uterus descends below its normal position due to weakening of pelvic floor muscles and ligaments. This often affects postmenopausal parous women due to estrogen deficiency. The patient may experience pulling down sensation, mass per vagina, white discharge per vagina, urinary complaints and rarely bowel problems. Here, a case of the postmenopausal woman presenting with mass per vagina is reported who on examination was found to have subacute intestinal obstruction.

Case Report

A 60-year-old parous female presented to our medical rural camp with mass per vagina since 1 year. On questioning, patient also complained of constipation since 1 week. The patient had no history of fever, melena, nausea and vomiting. Patient had attained menopause 10 years back and had no complaints of postmenopausal bleeding. General physical examination was normal. Vitals were stable. The abdomen was distended with diffuse tenderness (Figure 1). No rigidity, guarding or rebound tenderness were elicited. On auscultation, hyperactive bowel sounds were heard. No organomegaly was noted. Per vaginal examination revealed third degree uterine prolapse (Figure 1). Per rectal examination showed no stool on examining finger. With these findings, a diagnosis of subacute intestinal obstruction was made, and the patient was advised admission for surgical evaluation and gynecological management, but the patient refused and was lost for follow-up.

Discussion

The International Continence Society defined pelvic organ prolapse as descent of one or more vaginal segments: The anterior, the posterior, or the apex of the vagina (cervix/uterus) or vault after hysterectomy.[1] Prolapse development is multifactorial, with vaginal child birth, advancing age and increasing bodymass index as the most consistent risk factors.[2] Precipitating causes could be increased abdominal pressure due to chronic cough, constipation, and abdominal distension due to ascites or tumors.

Symptoms associated with genital prolapse (Table 1).[3]

Constipation can be a cause of and also effect of prolapse. There is a high prevalence of constipation and anorectal pain disorders in women with urinary incontinence and pelvic organ prolapse.[4] In our case, the patient had constipation, which was due to subacute intestinal obstruction. Mechanical bowel obstruction is a common emergency problem resulting in high morbidity and mortality.[5] Adhesions resulting from prior abdominal surgery are the predominant cause of small bowel obstruction, accounting for approximately 60% of cases[6] and less common causes of obstruction include intestinal intussusception, volvulus, intraabdominal abscesses[7] and malignancy.

Conclusion

Chronic constipation is often thought to be a cause or effect of uterovaginal prolapse. However in our case, constipation was secondary to subacute intestinal obstruction which might have been aggravated by the prolapse. Hence, there is a need for a thorough examination of a case as there could be other underlying serious conditions.