2. DEFINITION
Uterine prolapse is falling or sliding of the womb (uterus)
from its normal position into the vaginal area.
• Uterine prolapse (also called descensus or procidentia)
means the uterus has descended from its normal
position in the pelvis farther down into the vagina.
• Uterine prolapse is one type of pelvic organ prolapse ,
and it is the second most common after
cystourethrocele (bladder and urethral prolapse).
3.
4. Causes, incidence, and risk factors
-Muscles, ligaments, and other structures hold the uterus in the pelvis.
If these muscles and structures are weak, the uterus drops into the
vaginal canal . This is called prolapse.
-This condition is more common in women who have had one or more
vaginal births.
-Other things that can cause or lead to uterine prolapse include:
• Normal aging
• Lack of estrogen after menopause
• Anything that puts pressure on the pelvic muscles, including chronic
cough and obesity
• Pelvic tumor (rare)
-Long-term constipation and the pushing associated with it can make
this condition worse.
5. Symptoms
• Feeling like you are sitting on a small ball
• Difficult or painful sexual intercourse
• Frequent urination or a sudden urge to empty the bladder
• Low backache
• Uterus and cervix that stick out through the vaginal
opening
• Repeated bladder infections
• Feeling of heaviness or pulling in the pelvis
• Vaginal bleeding
• Increased vaginal discharge
-Many of the symptoms are worse when standing or sitting for
long periods of time.
6. Signs and tests
-A pelvic examination is done while you are bearing down, as if you
were trying to push out a baby. This shows your doctor how far
your uterus has dropped.
• Mild terine prolapse is mild when the cervix drops into the lower
part of the vagina.
• Uterine prolapse is moderate when the cervix drops out of the
vaginal opening.
-The pelvic exam may also show that the bladder and front wall of the
vagina (cystocele), or rectum and back wall of the vagina (rectocele)
are entering the vagina. The urethra and bladder may also be lower
in the pelvis than usual.
7. Treatment
- Treatment is not necessary unless the symptoms
bother you. Many women seek treatment by the
time the uterus drops to the opening of the vagina.
- Treatment is surgical, and the options
include hysterectomy or a uterus-sparing techniques
such as Hysteropexy or Manchester procedure.
8. LIFESTYLE CHANGES
• Weight loss is recommended in obese women with
uterine prolapse.
• Heavy lifting or straining should be avoided, because
they can worsen symptoms.
• Coughing can also make symptoms worse. If you a
chronic cough, ask your doctor how to prevent or
treat it. If you smoke, try to quit. Smoking can cause
a chronic cough.
9. VAGINAL PESSARY
• Your doctor may recommend placing a rubber or
plastic donut-shaped device, called a pessary, into
the vagina. This device hold the uterus in place. It
may be temporary or permanent. Vaginal pessaries
are fitted for each individual woman. Some are
similar to a diaphragm used for birth control.
• Pessaries must be cleaned from time to time,
sometimes by the doctor or nurse. Many women can
be taught how to insert, clean, and remove the
pessary herself.
10. Side effects of pessaries include:
• Foul smelling discharge from the vagina
• Irritation of the lining of the vagina
• Ulcers in the vagina
• Problems with normal sexual intercourse and
penetration
11. SURGERY
Surgery should not be done until the prolapse symptoms are worse
than the risks of having surgery. The specific type of surgery
depends on:
• Degree of prolapse
• Desire for future pregnancies
• Other medical conditions
• The women's desire to retain vaginal function
• The woman's age and general health
• There are some surgical procedures that can be done without
removing the uterus, such as a sacrospinous fixation . This
procedure involves using nearby ligaments to support the uterus.
Other procedures are available.
• Often, a vaginal hysterectomy is used to correct uterine prolapse.
Any sagging of the vaginal walls, urethra, bladder, or rectum can be
surgically corrected at the same time.
12. Expectations (prognosis)
• Most women with mild uterine prolapse do not have
bothersome symptoms and don't need treatment.
• Vaginal pessaries can be effective for many women
with uterine prolapse.
• Surgery usually provides excellent results, however,
some women may require treatment again in the
future.
13. Complications
• Ulceration and infection of the cervix and vaginal
walls may occur in severe cases of uterine prolapse.
• Urinary tract infections and other urinary symptoms
may occur because of a
cystocele. Constipation and hemorrhoids may occur
because of a rectocele.
14. Prevention
• Tightening the pelvic floor muscles using Kegel
exercises helps to strengthen the muscles and
reduces the risk of uterine prolapse.
• Estrogen therapy, either vaginal or oral, in
postmenopausal women may help maintain muscle
tone in the vaginal area.
