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 : 

  1. Uterine prolapse
  2. 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

Uterine Prolapse.

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.
  1. Difficulty in emptying the rectum.
  2. 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.

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