Symptoms of uterine prolaps :

1. Feeling of something coming down per vagina.
2. Backache
3. Dyspareunia.
4. Urinary symptoms:

• Difficulty in passing urine.
• Incomplete evacuation.
• Painful micturation.
• Stress incontinence.
• Retension of urine.

5. Difficulty in emptying the rectum.
6. Excessive white or blood stained vaginal discharge.

Signs of uterine prolaps :

Per vaginal examination: It depends upon presence, type and extent of prolapse.

A. 1st degree prolapse:

• Feeling of descent cervic on staining
• Speculum examination: Cervix will come down in the vagina on straining but will he within the introitus.

B. 2nd degree prolapse : .

. Inspection :

1. The cervix will lay outside the introitus, it will be identified by the presence of external os.
2. Rectocele may be present.
3. Decubitus ulcer may be present.

.Speculum examination: Enterocele and rectocele may be seen in posterior vaginal wall.

• Palpation : Cervix will be felt in between the anterior and posterior vaginal walls at the level of the introitus.

Rectal examination : Rectocele may be present.

C. 3rd  degree prolapse :

• Inspection:

1. A mass is protruded from the vaginal introitus.
2. Cystocele and rectocele may be present
3.  Ulceration in the prolapsed uterus.

.Palpation : At the level of the introinis, the anterior and posterior vaginal wall can be apposed and the fundus of the uterus will be felt outside the introitus

Investigations of uterine prolapse:

1. Blood for TC, DC. ESR and Hb%
2. Blood grouping, Rh typing and cross matching
3. Blood urea, serum creatinine
4. Blood sugar (fasting and two hours after meal)
5. Urine RM/E
6. Chest X-ray posterior and anterior view
7. ECG (if age 40 years).

Treatment of uterine prolapse :

A. Conservative treatment:

1. Improvement of general condition.
2. Oestrogen replacement therapy may improve minor degree prolapse in postmenopausal women.
3. Pelvic floor exercise in an attempt to strengthen the muscles

B. Surgical treatment :

1. Age >60 years Vaginal hysterectomy with anterior colponhaphy and posterior colpoperineonhaphy.
2. Age <40 years  :

• Family complete Fothergill’s operation with tubectomy.
• Family incomplete Fothergill’s operation.