UTERINE PROLAPSE

DEFINITION
The organs within a womans pelvis (uterus, bladder and rectum) are
normally held in place by ligaments and muscles known as the pelvic
floor.
If these are weakened, the pelvic organs can bulge (prolapse) from
their natural position into the vagina and this is known as pelvic organ
prolapse.
There are 3 components responsible for supporting the position of uterus and vagina
Ligaments and fascia by suspension from pelvic side walls
Levator ani muscles
Posterior angulation of vagina
Grading of prolapse
 Etiology

Pregnancy and childbirth

Ageing
Being overweight
Constipation, persistent coughing, prolonged
heavy lifting
Following a hysterectomy
Congenital
 How to Diagnose
Vaginal examination Differential diagnosis
Examining the patient in dorsal position, if it
protrudes beyond the introitus ; ulceration and Anterior wall prolapse : Congenital or
atrophy may be apparent inclusion dermoid vaginal cyst, urethral
diverticulum
Anterior and posterior vaginal wall and cervical
descent should be assessed with the patient Uterovaginal Prolapse: Large uterine polyp
straining in the left lateral position using Sims
Speculum
Combined rectal and vaginal digital examination
can be an aid to differentiate rectocele and
enterocele
Vaginal pelvic examination
Exclude pelvic mass
Bladder symptoms
Urine test to check for infection , BUSE/CR/
Renal USG
Obstructed defecation- MR Proctography
( to diagnose rectocele)
TREATMENT
Depends on - patients wishes No symptoms observation
- level of fitness - conservative therapy
- desire to preserve coital function Mild symptoms- pelvic floor physiotherapy
Symptomatic surgery
Prior to specific treatment , attempts made to
correct obesity , chronic cough and constipation
Medical & Surgery
Conservative
Support pessary plastic or silicone devise
which fits into your vagina to help support
pelvic organs
Need replacement annually
Complication: vaginal ulceration +
infection
Indications:
Patients wish
Therapeutic test
Childbearing not complete
Medically unfit
During / after pregnancy (involution)
While awaiting surgery
 SURGERY
To restore anatomy and function
Vaginal and abdominal operations designed to correct prolapse
(depends on womans desire to preserve coital function)

Cystourethrocele
Anterior repair ( colporrhaphy)

Rectocele
Posterior repair

Enterocele
Surgical principles similar as above but peritoneal sac containing small
bowel- excised