Uterine Prolapse

*Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and

weaken and no longer provide enough support for the uterus. As a result,

the uterus slips down into or protrudes out of the vagina.

*Uterine prolapse can occur in women of any age. But it often affects

postmenopausal women who've had one or more vaginal deliveries.

Definition:
-Uterine prolapse means the uterus has descended from its normal position

in the pelvis farther down into the vagina.

Degrees of prolapse:

-first degree: the uterus descends down from its anatomical position (external os at

the level ischial spines ) but the external os still remains inside vagina.

-second degree: the uterine cervix and body descends to lie outside the introitus.

It is also known as procidentia OR complete prolapse.

Sing and symptoms:
-Mild uterine prolapse generally doesn't cause signs or symptoms.

-signs and symptoms of moderate to severe uterine prolapse include:

-Sensation of heaviness or pulling in your pelvisTissue protruding from your vagina.

-Urinary problems, such as urine leakage (incontinence) or urine retention.

-Trouble having a bowel movement.

-Backache or dragging pain in the pelvis.

-dyspareunia.

-Feeling as if you're sitting on a small ball or as if something is falling out of your

vagina.

-Sexual concerns, such as a sensation of looseness in the tone of the vaginal tissue.

*Often, symptoms are less bothersome in the morning and worsen as the day

goes on.

Management:

-the management of uterine prolapse is described under the

following heading:

1.prevention.

2.physiotherapy.

3.pessary.
4.surgical treatment.

1.prevention:

-repeated childbirth with short intervals cause UV prolapse

-women should be advised to avoid pregnancies in quick succession labor.

1^st stage:

-avoid bearing down.

-breech or forceps delivery before full dilatation of cervix shouldn’t be attempted.

2^ed stage:

-avoid prolongation of this stage.

-perform episiotomy if tears or overstretching of perineum is feared.

3^rd stage:

-avoid crede’s method.

-episiotomy or tears should be carefully sutured.

*Puerperium:

-treat chronic cough and constipation.

-avoid strenuous exercises and standing for prolonged time.

2.physiotherapy:

-early cases of UV prolapse are helped by pelvic floor exercises particularly during

puerperium and while waiting to undergo surgical treatment.

-Kegel exercises are used to tone up pelvic musculature.

These exercises are done 3 times a day for 20 min.

Causes:
-Uterine prolapse results from the weakening of pelvic muscles and supportive

tissues.

-Causes of weakened pelvic muscles and tissues include:

-Pregnancy.

-Difficult labor delivery.

-trauma during childbirth.

-Delivery of a large baby.

-Being overweight obese.

-Lower estrogen level after menopause.

-Chronic constipation.

-straining with bowel movements.

-Chronic cough.

-bronchitis.

-Repeated heavy lifting.

Risk factors:
-One or more pregnancies.

-vaginal births.

-Giving birth to a large baby.

-Increasing age.

-Obesity.

-Prior pelvic surgery.

-Chronic constipation.

-frequent straining during bowel movements.

-Family history of weakness in connective tissue.

-Being Hispanic or white.

Complications:

-Uterine prolapse is often associated with prolapse of other pelvic organs.

-You might experience:

*Anterior prolapse (cystocele):

-Weakness of connective tissue separating the bladder and vagina may cause

the bladder to bulge into the vagina.

-Anterior prolapse is also called prolapsed bladder.

*Posterior vaginal prolapse (rectocele):

-Weakness of connective tissue separating the rectum and vagina may cause the

rectum to bulge into the vagina.

-You might have difficulty having bowel movements.

*Severe uterine prolapse can displace part of the vaginal lining, causing it to protrude

outside the body.

Diagnosis:
-A health care provider will ask about symptoms and perform a physical

examination

(rectal exam ,pelvic exam ,vaginal exam).

-While examining the pelvis, the provider will evaluate for organ placement

and vaginal tone.

-hematology.

×An ultrasound or MRI may help assess the severity of the prolapse.

Treatment:
-performing Kegel exercises regularly and correctly.

-performing and treating constipation.

-avoiding heavy lifting.

-using correct body mechanics whenever lifting is necessary.

-managing chronic cough.

-ingmaintaining a healthy weight through diet and exercise.

-considering estrogen replacement therapy during menopause.

×If the prolapse shows signs of worsening, other types of treatment may be
necessary.

*Surgery: Surgical repair of a prolapsed uterus can be performed through the vagina

or abdomen.

-It involves skin grafting, or using donor tissue or other material to provide uterine
suspension.

A hysterectomy may be recommended.