Uterine Prolapse

Uterine Prolapse

Uterus (or womb) is normally held in place inside pelvis with various muscles, tissue, and ligaments. Because of pregnancy, childbirth or difficult labor and delivery, in some women these muscles weaken. Also, as a woman ages and with a natural loss of the hormone estrogen, the uterus can drop into the vaginal canal, causing the condition known as a prolapsed uterus

Definition

Descend of uterus from its normal position in the pelvis further down into the vagina.

Types

First degree: The cervix drops into the vagina.

Second degree: The cervix drops to the level just inside the opening of the vagina.

Third degree: The cervix is outside the vagina.

Fourth degree: The entire uterus is outside the vagina. This condition is also called procidentia. This is caused by weakness of the supporting muscles.

Risk factors

•               Excess weight lifting

•               multiple deliveries

Causes

•               Pregnancy/childbirths with normal or complicated delivery through the vagina

•               Advancing age with weak pelvic muscles

•               Weakening and loss of tissue tone after menopause and loss of natural estrogen

•               increased pressure in the abdomen such as chronic cough

•               Major surgery in the pelvic area leading to loss of external support

•               Smoking

Signs and Symptoms

•               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 feeling of something is falling out of the vagina

•               Weak vaginal tissue

Diagnosis

Diagnose uterine prolapse with A medical history and physical examination of the pelvis.

•               Intra Venous Pyelogram (IVP)

•               Renal sonography.

•               X-rays.

•               Ultrasound.

•               Vaginal examination

•               Rectal examination.

Management

Prolapse up to the third degree may spontaneously resolve

Complications

•               Infertility

•               Abortion

•               Preterm labour

•               Risk of operative delivery

•               Anaemia due to heavy bleeding

•               Uterine cancer

Vaginal pessary: It is a removable device placed into the vagina.

Surgery: Hysterectomy

Nursing management

Teach and insist to practice Kegel exercise during pregnancy and post natal period

Exercise

•               Mild uterine prolapse can be treated with Kegel exercises

•               Tighten the pelvic floor muscles, as you are attempting to stop urinating and hold for 5 seconds

•               Take a 5-second break and repeat for three to 10 times per day.

•               Avoid more child birth.

Prevention

•               Maintain optimal weight.

•               Avoid constipation by eating a high-fiber diet.

•               Perform Kegel exercises to strengthen the pelvic muscles.

•               Avoid heavy lifting or straining. Preventing and treating constipation

•               Avoid chronic cough