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.

CausesThe 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.

SymptomsFeeling 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.

DiagnosisPatient's history symptoms

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.

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 prolapseFirst degree: The cervix droops into the vagina.

Second degree: The cervix sticks to the opening of the vagina.

Third degree: The cervix is outside the vagina.

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 treatmentMild 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 pessaryCI: 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 treatmentDepending 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 listWhat 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?

*14. Uterovaginal ProlapseBlock 17, March 31, 2008 Week 3 International Programmedr. Ova Emilia, M.M.Ed., Ph.D., Sp.OG