Uterine Prolapse
YouTube
Definition
Uterine prolapse is the descent of the uterus from its normal position into the vaginal canal due to weakening of pelvic floor
muscles and ligaments. It is classified as a type of pelvic organ prolapse (POP).
Etiology (Causes of Uterine Prolapse)
t
• Multiparity (Multiple Vaginal Deliveries) – Prolonged labor and large babies stretch pelvic muscles.
• Postmenopausal Age – Estrogen deficiency leads to atrophy of pelvic support structures.
• Obesity – Increased intra-abdominal pressure weakens pelvic ligaments.
• Chronic Increased Intra-Abdominal Pressure – Seen in chronic cough (COPD), constipation, and heavy lifting.
u
• Pelvic Surgery or Hysterectomy – Weakens pelvic support.
• Genetic Factors – Congenital pelvic muscle weakness or connective tissue disorders (e.g., Marfan syndrome).
Pathophysiology Types of Uterine Prolapse (Degrees of
a
The uterus is supported by muscular and ligamentous Descent)
structures.
Main Supportive Structures • 1st Degree (Mild) – Cervix descends into the vagina but
• Levator Ani Muscles (Pelvic Floor Muscles) – Provide active does not reach the introitus.
n
muscular support. • 2nd Degree (Moderate) – Cervix reaches the vaginal
• Uterosacral & Cardinal Ligaments – Provide ligamentous opening (introitus) but does not protrude outside.
support. • 3rd Degree (Severe or Complete Prolapse) – Cervix &
• Endopelvic Fascia – Helps in vaginal and uterine support. part of the uterus protrude outside the vagina.
h
When these structures weaken, intra-abdominal pressure • 4th Degree (Procidentia) – Entire uterus is outside the
pushes the uterus downward, leading to uterine prolapse. vaginal canal.
Normal
u
1st Degree
s 2nd Degree 3rd Degree 4th Degree
t
Clinical Features Management
Symptoms 1. Conservative Management (For Mild Cases, 1st & 2nd Degree)
• Pelvic Pressure & Heaviness – Dragging sensation in • Pelvic Floor Exercises (Kegel Exercises) – Strengthen levator ani
the lower abdomen and pelvis. muscles.
• Vaginal Bulge or Mass – Feeling or seeing something • Lifestyle Modifications – Weight loss, high-fiber diet (for
@
protruding from the vagina. constipation), and avoiding heavy lifting.
• Urinary Symptoms – Frequency, urgency, stress • Pessary Use – A rubber/silicone device placed in the vagina to
incontinence, or urinary retention. support the uterus.
• Bowel Symptoms – Constipation, incomplete • Topical Estrogen Therapy – For postmenopausal women to
evacuation, or fecal incontinence. improve vaginal and pelvic muscle tone.
• Dyspareunia (Painful Intercourse) – Due to vaginal
laxity. 2. Surgical Management (For Severe Cases, 3rd & 4th Degree)
• Lower Backache – Due to pelvic ligament stretching. • Vaginal Hysterectomy – Removal of the uterus for definitive
Signs (On Examination) treatment.
• Visible Uterine Descent – Notable on Valsalva • Sacrocolpopexy – Mesh suspension of the vaginal vault to the
maneuver (straining). sacrum for support.
• Weak Pelvic Floor Muscles – Assessed by perineal • Manchester Operation – Cervical amputation with uterosacral
muscle tone. ligament plication (for women desiring fertility).
• Associated Cystocele or Rectocele – Bladder or • Colpocleisis – Vaginal closure surgery (only in non-sexually active
rectum herniation into the vaginal wall. elderly women).
Like, Share & Subscribe | @TushNaut | Notes
