Utrine Prolapse

Uterine Prolapse
Uterine prolapse ("dropped uterus") is a condition in which a

woman's uterus (womb) sags or slips out of its normal position.
The uterus may slip enough that it drops partially into the
vagina (the birth canal), creating a perceptible lump or bulge.
This is called incomplete prolapse. In a more severe case—
known as complete prolapse—the uterus slips to such a degree
that some of the tissue drops outside of the vagina.
Uterus and the cervix lie at right angle of the long axis of the
vagina .As the uterus descends, it may pull the vaginal canal
and even the bladder and rectum with it. It is the second most
common after cystourethrocele (bladder and urethral
prolapse).
Prolapse Definition
Prolapse literally means "to fall out of place." In medicine,
prolapse is a condition where organs, such as the uterus,
fall down or slip out of place. It is generally reserved for
organs protruding through the vagina, or for the
misalignment of the valves of the heart.
Uterine prolapse (also called descensus or procidentia)

means the uterus has descended from its normal position
in the pelvis farther down into the vagina.
Displacement of the uterus within the pelvic cavity is classified
according to the direction of the displacement which are:
1. Retroversion - backward tilting of the uterus toward the

rectum.
2. Retroflexion - bending of the uterine corpus in

a back manner toward the rectum.
3. Anterversion - axaggerated forward tilting of the

uterus.
4. Anterflexion - flexing or folding of the uterine corpus

upon itself.
normal normal
normal
Retroversion Retroflexion Anterflexion

First degree (mild) of uterine
prolapse is defined as descent
of the uterus to any point in
the vagina above the hymen
Second degree (moderate)

uterine prolapse is defined as
descent to the hymen
Third degree (severe) - uterine

prolapse is defined as descent
beyond the hymen
2nd degree
3 degree
rd 1st degree
normal
History
Patient may complain of one or more of the following:
A feeling of heaviness or pressure in the pelvis

Feeling as if sitting on a small ball or as if something is falling
out of the vagina
Pain in the pelvis, abdomen, or lower back
Pain during intercourse
A protrusion of tissue from the vagina
Recurrent urinary tract infections (UTIs)
Unusual or excessive discharge from the vagina
Difficulty with urination, including involuntary loss of urine
(incontinence), or urinary frequency or urgency
Physical Examination
Performed to exclude the presence of an abdominal or pelvic

tumor that may be responsible for the prolapse.
Pelvic examination to assess the degree of prolapse is usually

performed with the woman either in the left lateral position
using a Sims speculum or in a semirecumbent position in the
examination chair.
Physical findings may be enhanced by having the patient strain

during the examination or by having her stand or walk.
Examination in a standing position allows an accurate
assessment of the degree of the prolapse.
Stages :
Stage I - Descent of the uterus to any point in the vagina

above the level of the hymen
Stage II - Descent to the level of the hymen
Stage III - Descent beyond the hymen
Stage IV - Total eversion or procidentia

Normal aging and lack of estrogen hormone after menopause
may also cause uterine prolapse.
Chronic cough and obesity increase the pressure on the pelvic

floor and may contribute to the prolapse.
Uterine prolapse can also be caused by a pelvic tumor,

although this is rare.
Chronic constipation and the pushing associated with it can

worsen uterine prolapse.
 Displacement or prolapsed of the uterus, bladder, or rectum
can be a congenital or an acquired condition.
 Congenital tilting or flexion of the uterus is rare.
 More commonly, tilting or flexion disorders in which the

uterus remains within the pelvic cavity are related to the:
i. Scarring and inflammation of pelvic inflammatory
disease.
ii. Endometriosis
iii. Pregnancy
iv. tumors
PATHOPHYSIOLOGY cont.
-Women with mild cases of uterine prolapse may have no obvious
symptoms. However, as the slipped uterus falls further out of
position, it can place pressure on other pelvic organs—such as the
bladder or bowel—causing a variety of symptoms, including:
Pelvic pressure: a feeling of heaviness or pressure in the pelvis

Pelvic pain: discomfort in the pelvis, abdomen or lower back
Pain during intercourse
A protrusion of tissue from the opening of the vagina
Recurrent bladder infections
Unusual or excessive discharge from the vagina
Constipation
Difficulty with urination, including involuntary -loss of urine (female
incontinence), or urinary frequency or urgency
One or more pregnancies and vaginal births
Giving birth to a large baby
Increasing age
Frequent heavy lifting
Chronic coughing
Frequent straining during bowel movements
-Trauma incurred during the birthing process, particularly
with large babies or after a difficult labor and delivery, is one
of the main causes of the muscle weakness that leads to
uterine prolapse. Reduced muscle tone from aging, as well
as lowered amounts of circulating estrogen after menopause,
may also form contributing factors in pelvic organ prolapses.
In rare circumstances, uterine prolapse may be caused by a
tumor in the pelvic cavity.
Genetics also may play a role; women of Northern European
descent experience a higher incidence of uterine prolapse
than do women of Asian and African heritage. Finally,
increased intra-abdominal pressure, stemming from such
diverse conditions as obesity, chronic lung disease and
asthma, can be contributing factors in uterine prolapse.
Screening & Diagnosis
-Diagnosing uterine prolapse requires a pelvic examination.

You may be referred to a doctor who specializes in
conditions affecting the female reproductive tract
(gynecologist). The doctor will ask about your medical
history, including how many pregnancies and vaginal
deliveries you've had. He or she will perform a complete
pelvic examination to check for signs of uterine prolapse.
You may be examined while lying down and also while
standing. Sometimes imaging tests, such as ultrasound or
magnetic resonance imaging (MRI), might be performed to
further evaluate the uterine prolapse. 7
Treatment
-Losing weight, stopping smoking and getting proper treatment for

contributing medical problems, such as lung disease, may slow the
progression of uterine prolapse.
-If you have very mild uterine prolapse, either without symptoms or
with symptoms that aren't highly bothersome, no treatment is
necessary. However, without treatment, you may continue to lose
uterine support, which could require future treatment.
Non-Surgical Options
Surgical Options Hysterectomy is a way of treating problems that

affect the uterus. Many conditions can be cured with hysterectomy.
Because it is major surgery, you may want to explore other
treatment options first. For conditions that have not responded to
other treatments, a hysterectomy may be the best choice. You
should be fully informed of all options before you decide.
Screening & Diagnosis
-Diagnosing uterine prolapse requires a pelvic examination.

You may be referred to a doctor who specializes in
conditions affecting the female reproductive tract
(gynecologist). The doctor will ask about your medical
history, including how many pregnancies and vaginal
deliveries you've had. He or she will perform a complete
pelvic examination to check for signs of uterine prolapse.
You may be examined while lying down and also while
standing. Sometimes imaging tests, such as ultrasound or
magnetic resonance imaging (MRI), might be performed to
further evaluate the uterine prolapse. 7
MEDICAL MANAGEMENT

Utrine Prolapse

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Uterine Prolapse

Uterine prolapse ("dropped uterus") is a condition in which a

Uterine prolapse (also called descensus or procidentia)

1. Retroversion - backward tilting of the uterus toward the

2. Retroflexion - bending of the uterine corpus in

3. Anterversion - axaggerated forward tilting of the

4. Anterflexion - flexing or folding of the uterine corpus

Retroversion Retroflexion Anterflexion

Second degree (moderate)

Third degree (severe) - uterine

A feeling of heaviness or pressure in the pelvis

Performed to exclude the presence of an abdominal or pelvic

Pelvic examination to assess the degree of prolapse is usually

Physical findings may be enhanced by having the patient strain

Stage I - Descent of the uterus to any point in the vagina

Stage II - Descent to the level of the hymen

Stage III - Descent beyond the hymen

Stage IV - Total eversion or procidentia

Chronic cough and obesity increase the pressure on the pelvic

Uterine prolapse can also be caused by a pelvic tumor,

Chronic constipation and the pushing associated with it can

 Congenital tilting or flexion of the uterus is rare.

 More commonly, tilting or flexion disorders in which the

Pelvic pressure: a feeling of heaviness or pressure in the pelvis

-Diagnosing uterine prolapse requires a pelvic examination.

-Losing weight, stopping smoking and getting proper treatment for

Surgical Options Hysterectomy is a way of treating problems that

-Diagnosing uterine prolapse requires a pelvic examination.

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