Uterine Prolapse.
Uterine Prolapse
Genital prolapse :
Define : Descent of the pelvic organs from its normal position in the pelvis through the vagina is known as genital prolapse
Types of genital prolapse :
- Uterine prolapse
- Vaginal prolapse.
Uterine Prolapse
We have described in article :
Clinical features of uterine prolapse
Symptoms and signs of uterine prolapse
Investigations of uterine prolapse
Treatment of uterine prolapse
Symptoms of uterine prolaps :
- Feeling of something coming down per vagina.
- Backache
- Dyspareunia.
- Urinary symptoms:
- Difficulty in passing urine.
- Incomplete evacuation.
- Painful micturation.
- Stress incontinence.
- Retension of urine.
- Difficulty in emptying the rectum.
- 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 :
- The cervix will lay outside the introitus, it will be identified by the presence of external os.
- Rectocele may be present.
- 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:
- A mass is protruded from the vaginal introitus.
- Cystocele and rectocele may be present
- 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:
- Blood for TC, DC. ESR and Hb%
- Blood grouping, Rh typing and cross matching
- Blood urea, serum creatinine
- Blood sugar (fasting and two hours after meal)
- Urine RM/E
- Chest X-ray posterior and anterior view
- ECG (if age 40 years).
Treatment of uterine prolapse :
A. Conservative treatment:
- Improvement of general condition.
- Oestrogen replacement therapy may improve minor degree prolapse in postmenopausal women.
- Pelvic floor exercise in an attempt to strengthen the muscles
B. Surgical treatment :
- Age >60 years Vaginal hysterectomy with anterior colponhaphy and posterior colpoperineonhaphy.
- Age <40 years :
- Family complete Fothergill’s operation with tubectomy.
- Family incomplete Fothergill’s operation.
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