• Group: 9.

• Under supervision:
Dr. Eman Mahmoud.
Dr. Amna Abo Hamed.

Uterine prolapse
 Group Individuals

1) Ahmed Abdelalim Sadad

2) Ahmed Abdelalim Sadad

3) Ahmed Abdullah Mohamed

4) Ahmed Osman Raghab

5) Aya Ahmed Sayed

6) Aya Ahmed Shaker

7) Aya Ahmed Fathallah

8) Aya Osama Mohamed

9) Aya Gamal Hassan

10) Aya Gamal Hussein

11) Aya Hussein saeed

12) Aya Hamad Eid

13) Aya Hanfi Mahmoud

 Outlines of uterine prolapse

• Introduction.
• Definition.
• Incidence.
• Types.
• Degrees.
• Causes.
• Symptoms.
• Diagnosis.
• Complications.
• Treatment.
• Prevention.
• Patient health Education.
Introduction

• Uterine prolapse is a condition in which the uterus

descends from its normal position into the vaginal
canal due to weakened pelvic floor muscles and
connective tissues. This displacement can result
from factors such as childbirth, aging, hormonal
changes, and chronic pressure from conditions like
obesity or chronic coughing.

• Understanding uterine prolapse is essential for

promoting women's health and encouraging those
affected to seek appropriate care.
Definition of uterine prolapse
• Uterine prolapse is a medical condition in which the uterus descends
from its normal anatomical position into the vaginal canal.

• Uterine prolapse is a form of female genital prolapse It is also called

pelvic organ prolapse or prolapse of the uterus (womb).

Incidence of Uterine Prolapse

• Uterine prolapse is relatively common, particularly among women
over 50. Studies suggest that about 50% of women may experience
some degree of pelvic organ prolapse during their lifetime, with
uterine prolapse being a significant component. The incidence
increases with age, particularly after menopause.
Type of uterine prolapse
1. Uterovaginal prolapse
• It's prolapse of the uterus , cervix & upper vagina
• Commonest type
• Combined by Cystocele

2. Congenital prolapse
• Often seen in nulliparous, so called nulliparous prolapse
• No cystocele
• Cause -congintal weakness of supports of uterus .

Supports of the uterus

A group of the muscle and ligaments support pelvic in it
places this muscle and ligaments weakend, they become
unable to hold the uterus in position and it begins to sag
Supports of the uterus is
• Cardinal ligaments
• Uterosacral ligaments
 • Pubocervical ligaments
• Round ligament
• Broad ligament
• Pelvic floor ligament

Degrees of uterine porlapse

• FIRST DEGREE: The uterus descends down from its anatomical

position (external os at the level of ischial spines) but the external os
still remains inside vagina.

• SECOND DEGREE: The external os protrudes outside the vaginal

introits but the uterine body still remains inside the vagina

• THIRD DEGREE: The uterine cervix and body descends to lie outside
the introitus. It is also known as Procidentia OR complete prolapse.

• Procidentia – Prolapse of the uterus with eversion of entire vagina. It

is inevitably associated with cystocele and an enterocele.
Causes of uterine porlapse

1. Childbirth: Vaginal deliveries, especially multiple births or those

involving large babies, can stretch and weaken the pelvic muscles
and ligaments.
2. Aging: As women age, especially after menopause, the levels of
estrogen decrease, leading to a weakening of pelvic tissues.
3. Genetics: A family history of prolapse or connective tissue disorders
can increase the risk.
4. Obesity: Excess weight can put additional pressure on the pelvic floor,
increasing the likelihood of prolapse.
5. Chronic Coughing: Conditions that cause chronic coughing (like
smoking or lung diseases) can increase intra-abdominal pressure.
6. Heavy Lifting: Frequent heavy lifting or straining during bowel
movements can weaken pelvic support structures.
7. Hormonal Changes: Changes in hormone levels, particularly during
menopause, can affect the strength of pelvic tissues.
8. Pelvic Surgery: Previous surgeries in the pelvic area can alter support
structures and lead to prolapse.
9. Neurological Conditions: Certain conditions that affect nerve
function can impact muscle control in the pelvic area.
10. Connective Tissue Disorders: Conditions like Ehlers-Danlos
syndrome can affect the strength and elasticity of connective tissues.
symptoms of uterine porlapse
1. Pelvic Pressure: A feeling of heaviness or pressure in the pelvic area, often
worsening with prolonged standing or physical activity.

2. Vaginal Bulging: A noticeable bulge or protrusion in the vagina, which may

be more pronounced when straining or during physical activities.

3. Urinary Issues: Increased frequency of urination, urgency, incontinence,

or difficulty emptying the bladder completely.

4. Bowel Problems: Constipation, difficulty with bowel movements, or a

sensation of incomplete evacuation.

5. Discomfort During Intercourse: Pain or discomfort during sexual activity

due to the position of the uterus.
6. Lower Back Pain: Chronic lower back pain that may be related to pelvic
support issues.

7. Menstrual Changes: Altered menstrual flow or increased menstrual

discomfort.

8. Fatigue: General fatigue due to chronic discomfort and strain on pelvic

muscles.

Diagnosis of uterine porlapse

Diagnosing uterine prolapse involves several steps, including a
comprehensive history, physical examination, laboratory
investigations, and medical imaging if necessary. Here’s a breakdown
of each component:

1. History

• Symptoms: Patients may report pelvic pressure, vaginal

bulging, urinary incontinence, or difficulty with bowel
movements.
• Obstetric History: Number of pregnancies, mode of delivery
(vaginal or cesarean), and any history of pelvic floor disorders.
• Menstrual History: Frequency, duration, and any abnormalities.
• Medical History: Chronic cough, constipation, or connective
tissue disorders.
• Lifestyle Factors: Physical activity level, weight, and smoking
history.

2. Physical Examination

• Pelvic Examination:

- Assess for pelvic organ prolapse using the Valsalva maneuver or

cough test.

- Inspect for any visible protrusion or bulging of the vaginal walls.

• Speculum Examination: To evaluate the vaginal walls and
cervix.
• Bimanual Examination: To assess the position of the uterus and
any associated masses.
3. Laboratory Investigations

• Urinalysis: To check for urinary tract infections or hematuria.

• Pap Smear: To rule out cervical pathology.
• Urodynamic Testing: May be indicated if urinary symptoms are
prominent, to assess bladder function.

4. Medical Imaging

• Ultrasound: Pelvic ultrasound can help visualize pelvic organs

and assess for other conditions.
• MRI: In complex cases, especially if surgical intervention is
being considered, an MRI may provide detailed images of the
pelvic anatomy.
Complications of uterine prolapse
1-Ulceration and Infection: As the uterus descends, vaginal tissues can
become irritated, leading to ulcer formation. These ulcers can become
infected if not treated.
2-Urinary Problems: Urinary Incontinence: Difficulty controlling urine flow,
leading to leakage.
3-Urinary Retention: Inability to completely empty the bladder, the risk of
urinary tract infections (UTIs) Frequent UTIs: Due to impaired bladder
emptying and urinary stasis.
5-Bowel Issues : Constipation: Pressure from increasing the prolapsed
uterus on the rectum can cause difficulty passing stools.
6-Fecal Incontinence: In severe cases, prolapse can weaken the pelvic floor
muscles, leading to loss of bowel control.
7-Vaginal Bleeding: Irritation and ulceration can cause vaginal discharge or
bleeding.
, particularly after physical activity.
8-Prolapse of Other Pelvic Organs: Cystocele (Bladder Prolapse): Prolapse of
the bladder into the vaginal space, often accompanying .
9-Emotional and Psychological Effects: Chronic discomfort, urinary
incontinence, can lead to depression, anxiety, and reduced quality of life.

In severe cases, the prolapsed uterus may extend completely outside the
vaginal opening, known as procidentia, which can complicate treatment and
require immediate intervention. Uterine prolapse. Rectocele (Rectal
Prolapse): Bulging of the rectum into the vaginal wall .
Treatment of uterine porlapse
1.Conservative Treatments:

• Pessaries: A pessary is a device inserted into the vagina to support the

uterus. It can be removed and cleaned regularly.

2. Medical Treatments:

• Hormone Therapy: For some women, especially those post-

menopause, hormone replacement therapy may help improve tissue
health and support.

3. Surgical Treatments:

• Uterine Suspension: This procedure repositions the uterus and

supports it with stitches.
• Hysterectomy: In severe cases, the uterus may be surgically
removed, often combined with pelvic floor repair.
• Vaginal or Abdominal Repassary.

4. Follow-Up Care:

Regular follow-up with a healthcare provider is essential to monitor

symptoms and adjust treatment as nece.
Prevention of uterine prolapse
• Family planning/Child spacing to avoid repeated child birth.
• Proper selection of patients for instrumental delivery.
• Weight reduction/prevention of Obesity.
• Stop smoking.
• Good repair of episiotomy and perineal tears after labour.
• Avoid constipation in pueperium.
• Encourage postnatal exercises.

Women should be advised to avoid pregnancies in quick succession Labour.

1.1ststage:

-Avoid bearing down.

-Breech or forceps delivery before full dilatation of cervix shouldn't be

attempted.
2. 2nd stage:

-Avoid prolongation of this stage.

-Perform episiotomy if tears or overstretching of perineum is feared.

3. 3rd stage:

-Avoid Crede's method.

-Episiotomy or tears should be carefully sutured.

4. Pecraeriom:

-Treat chronic cough and constipation.

-Avoid strenuous exercises and standing for prolonged time.

Health Education for uterine porlapse
1. Exercise

• Kegel- Exercises: Strengthen pelvic floor muscles.

• Low-impact - Activities: Engage in walking, swimming, or cycling to
promote overall fitness without straining the pelvic area.

2. Medication

• Hormonal Therapy: Discuss with a healthcare provider if estrogen

therapy is appropriate, especially for postmenopausal women.
• Pain Relief: Over-the-counter pain relievers (e.g., ibuprofen) can help
manage any discomfort associated with prolapse.

3- Lifestyle

• Avoid Straining: Limit heavy lifting and straining during bowel

movements. Consider stool softeners if constipation is an issue.
• Smoking Cessation: If you smoke, seek resources to quit, as smoking
can worsen prolapse through chronic coughing.

4. Sleep and Position

• Sleep Position: Sleeping on your side can reduce pressure on the pelvic
area. Use a pillow between your knees for added support.
• Elevating the Hips: Some patients find it helpful to elevate their hips
slightly with a pillow to relieve pressure.
5. Diet

• High-Fiber Foods: Incorporate fruits, vegetables, whole grains, and

legumes to prevent constipation.
• Hydration: Drink plenty of water to support digestion and overall
health.
• Avoid Excessive Caffeine and Alcohol: These can irritate the bladder
and worsen symptoms.

6. Follow-Up

• Regular Check-ups: Schedule routine appointments with a healthcare

provider to monitor the condition and adjust the management plan as
needed.
• Discuss Symptoms: Keep track of any changes or worsening
symptoms, and communicate these during follow-up visits.
Reference

1. Lewis, S. L., Bucher, L., Heitkemper, M. M., & Harding, M. M. (2019).

Medical-Surgical Nursing: Assessment and Management of Clinical
Problems (11th ed.). Elsevier.

This textbook provides detailed nursing interventions and management

strategies for various medical conditions, including anemia.

2. Hinkle, J. L., & Cheever, K. H. (2021). Brunner & Suddath’s

Textbook of Medical-Surgical Nursing (15th ed.). Wolters Kluwer.

Another comprehensive source for medical-surgical nursing that covers the

pathophysiology, management, and nursing care for patients with anemia.

3. American Society of Hematology (ASH) Guidelines:

The ASH provides evidence-based guidelines for the management of

anemia, especially for specific types like iron deficiency anemia and anemia
related to chronic disease.

You can find the guidelines on their website: https://www.hematology.org.

4. Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heim Gartner, N. M.

(2020). Medical-Surgical Nursing: Concepts for Interprofessional
Collaborative Care (10th ed.). Elsevier.

This book focuses on a concept-based approach to nursing care, including

the management of anemia.

5. Nursing Care of Patients with Anemia. (n.d.). NursingCentral.com.

An online resource offering up-to-date nursing guidelines on managing

anemia. Visit Nursing Central for more information.

These references will provide you with the theoretical and practical
knowledge needed to manage anemia in nursing practice.