A late middle-aged mother who is certain she is not pregnant tells the nurse at an office visit that ...

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1, 3, 4. Incorrect. Cystocele is the protrusion of the bladder downward into the vagina; rectocele is herniation of the anterior rectal wall through a relaxed or ruptured vaginal fascia. Both can present as a bearing-down sensation with urinary dysfunction. They occur more often in older women who have borne children.
2. Correct. Cystocele is the protrusion of the bladder downward into the vagina; rectocele is herniation of the anterior rectal wall through a relaxed or ruptured vaginal fascia. Both can present as a bearing-down sensation with urinary dysfunction. They occur more often in older women who have borne children.