PROLAPSED UTERUS

Definition
Prolapse refers to a collapse,
descent, of other change in the
position of the uterus in relation to
surrounding
structures in the pelvis.

Causes
The pelvic support system, the muscles and ligaments that
normally hold the uterus in place, become stretched or
slack,
Most often due to a long or difficult childbirth or multiple
childbirths.
Chronic increases in intra-abdominal pressure, such as may
be associated with obesity, abdominal or pelvic tumors,
ascites, or repetitive downward thrusts of intra-abdominal
pressure that may be due to coughing, constipation, or
occupational stresses, can cause funneling of a weakened
pelvic diaphragm and pelvic organ prolapse.
Post-reproductive years.

Symptoms
1.
2.
3.
4.
5.
6.

Feeling of heaviness, fullness or "falling out" in

the vaginal area.
Backache or inability to control urination.
the cervix may be seen protruding (impression
that a tumor is bulging out of her vagina).
Cervix or vaginal epithelium become damaged
or ulcerated (pain or vaginal bleeding).
Discharge from the cervix and vagina when
secondary infection occurs.
Difficulty walking comfortably.

Diagnosis
1.

Patient's history symptoms

2.

A pelvic examination is performed to determine

which organs are involved, the extent to which
each descends, and the location of any pelvic
support defects.

3.

If the prolapse is due to disease or swelling, the

underlying cause or disorder must first be
controlled or eliminated before the uterus can
be returned to its original position and secured
there.

Degree of prolapse
1. First degree: The cervix droops into the vagina.
2. Second degree: The cervix sticks to the opening
of the vagina.
3. Third degree: The cervix is outside the vagina.
4. Fourth degree: The entire uterus is outside the
vagina. This condition is also called procidentia.
This is caused by weakness in all of the
supporting muscles.

Non surgical treatment

Mild cases, exercises to strengthen the
muscles of the pelvic floor
An obese patient may be encouraged to
lose weight in order to reduce pressure
on the pelvic organs.
Not to wear constricting clothing (such
as girdles), and they should avoid lifting
heavy objects.
A pessary (a plastic ring)
.

The weakness of pessary

CI: Acute pelvic infections and
fixed uterine retroversion
All pessaries should be removed,
cleaned, and reinserted at regular
intervals.
Sometimes cause pelvic
discomfort, vaginal discharge,
vaginal ulceration, and bleeding

Surgical treatment
Depending on the degree of prolapse, the
condition of the pelvic support system, and which
other structures are involved.
Post-menopausal woman, HRT for at least 30 days
may help improve the vitality of the vaginal
epithelium, the cervix, and the vasculature (blood
supply) of these organs, making the operative
procedure and the healing process more efficient.
Abdominal route, the vaginal route, or a
combination of both.

Clinical Practice check list

What degree of prolapse is it?
What soft tissues or other structures are
weakened or involved?
What is the likely cause?
Will surgery be necessary to correct the
condition?
If so, what procedure will be performed and
how will it be performed? What are the risks
of surgery? Are there any risks or
complications after surgery? How long will it
take for recovery? What are some precautions
that need to be taken after surgery?