Uterine Prolapse Submitted by Bharat Malhotra

8/2/2019 Uterine Prolapse Submitted by Bharat Malhotra

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UTERINE

PROLAPSESUBMITTED BY-

BHARAT MALHOTRA


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Definition

Uterus (womb in which a fetus develops) is normally held

in place inside pelvis with various muscles, tissue, and

ligaments. Sometimes-because of childbirth or

difficult labor and delivery-these muscles weaken.

As a woman ages and with a natural loss of the hormone

estrogen, her uterus can collapse into the vaginal canal,

causing the condition known as a prolapsed uterus.


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Types Muscle weakness or relaxation may allow the uterus to

sag or come completely out of the body to a variable

extent. Prolapsed uterus can be described in the

following stages:

First degree: The cervix remains into the vagina.

Second degree: A descent of cervix in introitus, which

may protrude further on straining, with the possibility of

damage, infection & ulceration.

Third degree: (procidentia): The entire uterus descends

outside the introitus of body, causing total inversion of

vagina.


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Associated Conditions

Other conditions are usually associated with prolapsed uterus. Theyweaken the muscles that hold the uterus in place:

Cystocele: A herniation (or bulging) of the upper front vaginal wallwhere a part of bladder bulges into the vagina, which may lead to

urinary frequency, urgency, retention, and incontinence.

Enterocele: The herniation of the upper rear vaginal wall where asmall bowel portion bulges into the vagina. Standing leads to apulling sensation and backache and is relieved when lying down.

Rectocele: The herniation of the lower rear vaginal wall where therectum bulges into the vagina. This makes bowel movementsdifficult to the point that the woman may need to push on theinside of the vagina to empty the bowel.


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Who Gets Uterine Prolapse?

Uterine prolapse most often occurs in women who have

had more than one baby through normal vaginal delivery

and in post-menopausal women. Menopause occurs

when a woman's ovaries stop producing the hormones

that regulate her monthly menstrual cycle, and she stops

having regular menstrual periods. One of these

hormones, estrogen, helps keep the pelvic muscles

strong.


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Causes

The following conditions can cause a prolapsed uterus:

Pregnancy/multiple childbirths with normal or

complicated delivery through the vagina

Weakness in the pelvic muscles with advancing age

Weakening and loss of tissue tone after menopause and

loss of natural estrogen


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Conditions leading to increased pressure in the abdomen such as

chronic cough (with bronchitis and asthma), straining

(with constipation), pelvic tumors (rare), or an accumulation of fluid

in the abdomen

Being overweight or obese with its additional strain on pelvic

muscles

Major surgery in the pelvic area leading to loss of external support

Other risk factors include:

Excess weight lifting

Being Caucasian: Caucasian women more commonly affected;African Americans and Asians are affected less often.


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Symptoms Symptoms of a prolapsed uterus include:

A feeling of fullness or pressure in pelvis (may describe it

as a feeling of sitting on a small ball)

Low back pain

Feeling that something is coming out of vagina

Painful sexual intercourse

Difficulty with urination or moving your bowels

Difficult walkin


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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.


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Diagnosis

If a woman experiences symptoms associated with

prolapse she should consult her doctor.

The doctor will take her medical history and then

perform a vaginal examination. A rectal examination mayalso be performed if a rectocele or enterocele is

suspected.

The woman may be asked to cough or push down during

the examination as this raises the pressure in theabdomen and pushes any prolapse downwards, making it

easier to see or feel.

Coughing or pushing down can also help identify any

associated stress incontinence.


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These examinations may also been conducted while the

woman is in a standing position.

The doctor will also carry out a thorough abdominal

examination to ensure there are no other pelvicproblems.

If a woman also has incontinence it may be necessary to

conduct other tests to fully investigate the cause/s of

this.


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Treatment

There are surgical and non-surgical options for treating

uterine prolapse. The treatment chosen will depend on

the severity of the condition, as well as the woman's

general health, age and desire to have children.

Treatment generally is effective for most women.

Treatment options include the following:


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Non-Surgical Options

Exercise Special exercises, called Kegel exercises, can

help strengthen the pelvic floor muscles. This may be the

only treatment needed in mild cases of uterine prolapse.

To do Kegel exercises, tighten your pelvic muscles as if

you are trying to hold back urine. Hold the muscles tight

for a few seconds and then release. Repeat 10 times. You

may do these exercises anywhere and at any time (up to

four times a day).


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Vaginal pessary A pessary is a rubber or plastic

doughnut-shaped device that fits around or under the

lower part of the uterus (cervix), helping to prop up the

uterus and hold it in place. A health care provider will fit

and insert the pessary, which must be cleaned frequently

and removed before sex.


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Estrogen replacement therapy (ERT) Taking estrogen

may help to limit further weakness of the muscles and

other connective tissues that support the uterus.


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Surgical Options

Hysterectomy Uterine prolapse may be treated by

removing the uterus in a surgical procedure called

hysterectomy. This may be done through an incision

made in the vagina (vaginal hysterectomy) or through the

abdomen (abdominal hysterectomy). Hysterectomy is

major surgery, and removing the uterus means

pregnancy is no longer possible.


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Uterine suspension This procedure involves putting the

uterus back into its normal position. This may be done by

reattaching the pelvic ligaments to the lower part of the

uterus to hold it in place. Another technique uses a

special material that acts like a sling to support the

uterus in its proper position. Recent advances include

performing this with minimally invasive techniques and

laparoscopically (through small band aid sized incisions)

that decrease post operative pain and speed recovery.


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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.


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Prevention While women have little control over some contributing

factors to prolapse (eg., having a long labour or giving

birth to a large infant), there are a number of other stepsthey can take to reduce their risk.

Perform pelvic floor exercises regularly, particularly

during pregnancy after childbirth and into menopause.

Avoid constipation and straining during a bladder and

bowel movement.

Treat the cause of any chronic cough (if it is smoking-

related seek assistance in quitting). Maintain a healthy weight.

Avoid lifting heavy objects frequently. If lifting heavy

objects, make sure to bend at the knees and keep the

back straight.


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THANK YOU!!

Documents

Uterine Prolapse Submitted by Bharat Malhotra