Uterine Prolapse
Uterine prolapse is a common condition that affects approximately 50% of postmenopausal women who have given birth. It occurs more frequently in women who had multiple births by vaginal delivery, but it can also develop in women who did not bear children.
Preventive efforts include managing chronic breathing problems, not smoking, and maintaining a healthy weight. Mild cases may be treated with a pessary together with hormone replacement therapy. More severe cases may require surgery such as a vaginal hysterectomy. About 14% of women are affected. It occurs most commonly after menopause.
Definition:
Uterine prolapse (also called descensus or procidentia) means the uterus has descended from its normal position in the pelvis farther down into the vagina. See image below. Normal uterus versus a prolapsed uterus.
Symptoms
Symptoms vary depending on how severe the prolapse is.
Typical symptoms include:
• pelvic heaviness or pulling
• vaginal bleeding or an increase in vaginal discharge
• difficulties with sexual intercourse
• urinary leakage, retention or bladder infections
• bowel movement difficulties, such as constipation
• lower back pain
• uterine protrusion from the vaginal opening
• sensations of sitting on a ball or that something is falling out of the vagina
• weak vaginal tissue
In mild cases, there may be no symptoms. Symptoms that appear only sometimes often become worse toward the end of the day.
Pathophysiology and causes
The uterus (womb) is normally held in place by a hammock of muscles and ligaments. Prolapse happens wh en the ligaments supporting the uterus become so weak that the uterus cannot stay in place and slips down from its normal position. These ligaments are the round ligament, uterosacral ligaments, broad ligament and the ovarian ligament. The uterosacral ligaments are by far the most important ligaments in preventing uterine prolapse.
In some cases of uterine prolapse, the uterus can be unsupported enough to extend past the vaginal wall for inches.[5]
The most common cause of uterine prolapse is trauma during childbirth, in particular multiple or difficult births. About 50% of women who have had children develop some form of pelvic organ prolapse in their lifetime.[6] It is more common as women get older, particularly in those who have gone through menopause. This condition is surgically correctable.
Pelvic floor muscles can become weak for a number of reasons:
• pregnancy
• factors related to delivery, including trauma, delivering a large baby, or having a vaginal delivery
• getting older, especially after menopause, when levels of circulating estrogen drop
• frequent heavy lifting
• straining during bowel movements
• chronic coughing
• a history of pelvic surgery
• genetic factors leading to weakened connective tissue
Diagnosis and Investigations:
Pelvic exam
A diagnosis of uterine prolapse generally occurs during a pelvic exam.
During the pelvic exam your doctor is likely to ask you:
To bear down as if having a bowel movement. Bearing down can help your doctor assess how far the uterus has slipped into the vagina.
To tighten your pelvic muscles as if you're stopping a stream of urine. This test checks the strength of your pelvic muscles.
You might fill out a questionnaire that helps your doctor assess how uterine prolapse affects your quality of life. This information helps guide treatment decisions.
If you have severe incontinence, your doctor might recommend tests to measure how well your bladder functions (urodynamic testing).
Types of pessaries
Utrovagianl prolapse: It is the prolapse of uterus, cervix and upper vagina.
- It is the commonest type.
- It is accompanied by cystoccle.
Congenital uterovaginal prolapse is a result of weakness in the pelvic muscle and ligaments; this weakness could be either secondary to congenital weakness in the pelvic musculature or defective innervation. The pelvic muscle support is normally innervated by the perineal branch of the sacral nerve.
Stages
The uterus, also known as the womb, is held above the vagina by the pelvic floor muscles and ligaments.
Uterine prolapse can be categorized as incomplete or complete:
Incomplete uterine prolapse: The uterus is partially displaced into the vagina but does not protrude.
Complete uterine prolapse: A portion of the uterus protrudes from the vaginal opening.
The condition is graded by its severity, determined by how far the uterus has descended:
• 1st grade: descended to the upper vagina
• 2nd grade: descended to the introitus
• 3rd grade: cervix has descended outside the introitus
• 4th grade: cervix and uterus have both descended outside the introitus
More severe cases may need surgery, but in the early stages, exercises may help.
Treatment
Prolapse up to the third degree may spontaneously resolve. More severe cases may require medical treatment.
Options include:
Vaginal pessary: This is a vaginal device that supports the uterus and keeps it in position. It is important to follow the instructions on care, removal, and insertion of the pessary. In cases of severe prolapse, a pessary can cause irritation, ulceration, and sexual problems. Discuss with your provider if this treatment is right for you.
Surgery: Surgical repair of a prolapsed uterus can be performed through the vagina or abdomen. It involves skin grafting, or using donor tissue or other material to provide uterine suspension. A hysterectomy may be recommended.
If future pregnancies are intended, surgery may not be recommended, due to the risks of undoing the effects of surgical repair.
Fast facts on uterine prolapse
Here are some key points about uterine prolapse. More detail is in the main article.
Uterine prolapse is a relatively common condition in which the uterus drops when the pelvic muscles become too weak to support it.
Risk factors include having a high body mass index (BMI), having completed menopause, and pregnancy and childbirth.
Symptoms include urine leaks, discomfort in the pelvic area, and lower back pain.
Kegel exercises are important for treating mild forms of uterine prolapse.
Preparing for your appointment
You may be referred to a gynecologist.
Here's some information to help you get ready for your appointment.
What you can do
• List symptoms you've been having, and for how long
• List all medications, vitamins and supplements you take, including the doses
• List key personal and medical information, including other conditions, recent life changes and stressors
• Prepare questions to ask your doctor
For uterine prolapse, some basic questions to ask your doctor include:
• What can I do at home to ease my symptoms?
• What are the chances that the prolapse will worsen if I don't do anything?
• What treatment approach do you recommend?
• What's the likelihood that the uterine prolapse will recur if I have it surgically treated?
• What are the risks of surgery?
A uterine prolapse is when the uterus descends toward or into the vagina. It happens when the pelvic floor muscles and ligaments become weak and are no longer able to support the uterus.
In some cases, the uterus can protrude from the vaginal opening.
Complications can sometimes result, including ulceration of exposed tissue and prolapse of other pelvic organs such as the bladder or the rectum.
Among women aged 55 years and above, it is one of the most common reasons for undergoing a hysterectomy.
Bugge C, Adams EJ, Gopinath D, Reid F (2013). "Pessaries (mechanical devices) for pelvic organ prolapse in women" (PDF). Cochrane Database Syst Rev (2): CD004010. doi:10.1002/14651858.CD004010.pub3. PMID 23450548.
Cundiff GW, Amundsen CL, Bent AE, Coates KW, Schaffer JI, Strohbehn K, Handa VL (2007). "The PESSRI study: symptom relief outcomes of a randomized crossover trial of the ring and Gellhorn pessaries". Am. J. Obstet. Gynecol. 196 (4): 405.e1–8. doi:10.1016/j.ajog.2007.02.018. PMID 17403437.
D'Amico D, Barbarito C (2015). Health & physical assessment in nursing (3rd ed.). Boston. p. 665. ISBN 9780133876406. OCLC 894626609.
Hagen, Suzanne (2011). "Conservative prevention and management of pelvic organ prolapse in women". The Cochrane Library (12): CD003882. doi:10.1002/14651858.CD003882.pub4. PMID 22161382.
Maher, Christopher; Feiner, Benjamin; Baessler, Kaven; Christmann-Schmid, Corina; Haya, Nir; Brown, Julie (2016). "Surgery for women with apical vaginal prolapse" (PDF). The Cochrane Database of Systematic Reviews. 10: CD012376. doi:10.1002/14651858.CD012376.
Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, Gantz M, Fine P, Menefee S, Ridgeway B, Visco A, Warren LK, Zhang M, Meikle S (2013). "Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse". JAMA. 309 (19): 2016–24. doi:10.1001/jama.2013.4919. PMC 3747840. PMID 23677313.
Preventive efforts include managing chronic breathing problems, not smoking, and maintaining a healthy weight. Mild cases may be treated with a pessary together with hormone replacement therapy. More severe cases may require surgery such as a vaginal hysterectomy. About 14% of women are affected. It occurs most commonly after menopause.
Definition:
Uterine prolapse (also called descensus or procidentia) means the uterus has descended from its normal position in the pelvis farther down into the vagina. See image below. Normal uterus versus a prolapsed uterus.
Symptoms
Symptoms vary depending on how severe the prolapse is.
Typical symptoms include:
• pelvic heaviness or pulling
• vaginal bleeding or an increase in vaginal discharge
• difficulties with sexual intercourse
• urinary leakage, retention or bladder infections
• bowel movement difficulties, such as constipation
• lower back pain
• uterine protrusion from the vaginal opening
• sensations of sitting on a ball or that something is falling out of the vagina
• weak vaginal tissue
In mild cases, there may be no symptoms. Symptoms that appear only sometimes often become worse toward the end of the day.
Pathophysiology and causes
The uterus (womb) is normally held in place by a hammock of muscles and ligaments. Prolapse happens wh en the ligaments supporting the uterus become so weak that the uterus cannot stay in place and slips down from its normal position. These ligaments are the round ligament, uterosacral ligaments, broad ligament and the ovarian ligament. The uterosacral ligaments are by far the most important ligaments in preventing uterine prolapse.
In some cases of uterine prolapse, the uterus can be unsupported enough to extend past the vaginal wall for inches.[5]
The most common cause of uterine prolapse is trauma during childbirth, in particular multiple or difficult births. About 50% of women who have had children develop some form of pelvic organ prolapse in their lifetime.[6] It is more common as women get older, particularly in those who have gone through menopause. This condition is surgically correctable.
Pelvic floor muscles can become weak for a number of reasons:
• pregnancy
• factors related to delivery, including trauma, delivering a large baby, or having a vaginal delivery
• getting older, especially after menopause, when levels of circulating estrogen drop
• frequent heavy lifting
• straining during bowel movements
• chronic coughing
• a history of pelvic surgery
• genetic factors leading to weakened connective tissue
Diagnosis and Investigations:
Pelvic exam
A diagnosis of uterine prolapse generally occurs during a pelvic exam.
During the pelvic exam your doctor is likely to ask you:
To bear down as if having a bowel movement. Bearing down can help your doctor assess how far the uterus has slipped into the vagina.
To tighten your pelvic muscles as if you're stopping a stream of urine. This test checks the strength of your pelvic muscles.
You might fill out a questionnaire that helps your doctor assess how uterine prolapse affects your quality of life. This information helps guide treatment decisions.
If you have severe incontinence, your doctor might recommend tests to measure how well your bladder functions (urodynamic testing).
Types of pessaries
Utrovagianl prolapse: It is the prolapse of uterus, cervix and upper vagina.
- It is the commonest type.
- It is accompanied by cystoccle.
Congenital uterovaginal prolapse is a result of weakness in the pelvic muscle and ligaments; this weakness could be either secondary to congenital weakness in the pelvic musculature or defective innervation. The pelvic muscle support is normally innervated by the perineal branch of the sacral nerve.
Stages
The uterus, also known as the womb, is held above the vagina by the pelvic floor muscles and ligaments.
Uterine prolapse can be categorized as incomplete or complete:
Incomplete uterine prolapse: The uterus is partially displaced into the vagina but does not protrude.
Complete uterine prolapse: A portion of the uterus protrudes from the vaginal opening.
The condition is graded by its severity, determined by how far the uterus has descended:
• 1st grade: descended to the upper vagina
• 2nd grade: descended to the introitus
• 3rd grade: cervix has descended outside the introitus
• 4th grade: cervix and uterus have both descended outside the introitus
More severe cases may need surgery, but in the early stages, exercises may help.
Treatment
Prolapse up to the third degree may spontaneously resolve. More severe cases may require medical treatment.
Options include:
Vaginal pessary: This is a vaginal device that supports the uterus and keeps it in position. It is important to follow the instructions on care, removal, and insertion of the pessary. In cases of severe prolapse, a pessary can cause irritation, ulceration, and sexual problems. Discuss with your provider if this treatment is right for you.
Surgery: Surgical repair of a prolapsed uterus can be performed through the vagina or abdomen. It involves skin grafting, or using donor tissue or other material to provide uterine suspension. A hysterectomy may be recommended.
If future pregnancies are intended, surgery may not be recommended, due to the risks of undoing the effects of surgical repair.
Fast facts on uterine prolapse
Here are some key points about uterine prolapse. More detail is in the main article.
Uterine prolapse is a relatively common condition in which the uterus drops when the pelvic muscles become too weak to support it.
Risk factors include having a high body mass index (BMI), having completed menopause, and pregnancy and childbirth.
Symptoms include urine leaks, discomfort in the pelvic area, and lower back pain.
Kegel exercises are important for treating mild forms of uterine prolapse.
Preparing for your appointment
You may be referred to a gynecologist.
Here's some information to help you get ready for your appointment.
What you can do
• List symptoms you've been having, and for how long
• List all medications, vitamins and supplements you take, including the doses
• List key personal and medical information, including other conditions, recent life changes and stressors
• Prepare questions to ask your doctor
For uterine prolapse, some basic questions to ask your doctor include:
• What can I do at home to ease my symptoms?
• What are the chances that the prolapse will worsen if I don't do anything?
• What treatment approach do you recommend?
• What's the likelihood that the uterine prolapse will recur if I have it surgically treated?
• What are the risks of surgery?
A uterine prolapse is when the uterus descends toward or into the vagina. It happens when the pelvic floor muscles and ligaments become weak and are no longer able to support the uterus.
In some cases, the uterus can protrude from the vaginal opening.
Complications can sometimes result, including ulceration of exposed tissue and prolapse of other pelvic organs such as the bladder or the rectum.
Among women aged 55 years and above, it is one of the most common reasons for undergoing a hysterectomy.
Bugge C, Adams EJ, Gopinath D, Reid F (2013). "Pessaries (mechanical devices) for pelvic organ prolapse in women" (PDF). Cochrane Database Syst Rev (2): CD004010. doi:10.1002/14651858.CD004010.pub3. PMID 23450548.
Cundiff GW, Amundsen CL, Bent AE, Coates KW, Schaffer JI, Strohbehn K, Handa VL (2007). "The PESSRI study: symptom relief outcomes of a randomized crossover trial of the ring and Gellhorn pessaries". Am. J. Obstet. Gynecol. 196 (4): 405.e1–8. doi:10.1016/j.ajog.2007.02.018. PMID 17403437.
D'Amico D, Barbarito C (2015). Health & physical assessment in nursing (3rd ed.). Boston. p. 665. ISBN 9780133876406. OCLC 894626609.
Hagen, Suzanne (2011). "Conservative prevention and management of pelvic organ prolapse in women". The Cochrane Library (12): CD003882. doi:10.1002/14651858.CD003882.pub4. PMID 22161382.
Maher, Christopher; Feiner, Benjamin; Baessler, Kaven; Christmann-Schmid, Corina; Haya, Nir; Brown, Julie (2016). "Surgery for women with apical vaginal prolapse" (PDF). The Cochrane Database of Systematic Reviews. 10: CD012376. doi:10.1002/14651858.CD012376.
Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, Gantz M, Fine P, Menefee S, Ridgeway B, Visco A, Warren LK, Zhang M, Meikle S (2013). "Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse". JAMA. 309 (19): 2016–24. doi:10.1001/jama.2013.4919. PMC 3747840. PMID 23677313.
0 Comments