UTERINE PROLAPS
SHUBHAM B. KENDRE
4th yr
CONANTENT
●
●
●
●
●
●
●
DEFINITION
CAUSES
CLASSIFICATION
COMPLICATION [after occurance & after surgery]
INVESTIGATION
DIAGNOSIS
TREATMENT
Defination
Is the downward displacement of the uterus into the vaginal canal or a
gradually descends of the uterus in the axix of the vagina involving the
viginal wall with it .
or simply , the hernation of the uterus in vagina.
Causes
1.
2.
3.
4.
5.
6.
Atonicity & asthenia following menopause
birth injury
rapid suction delivery
increased intra abdominal pressure and simultanous cough
excesssive streatch on pelvic floor muscle
peripheral nerve injury eg ..pudenal nerve , during childbirth
7. circumstances like, heavy weight lefting soon after delivery the ideal
timeing to weight lift min. after 3 months
8. prolapse seen in unmarried or nulliparous women also in girls if there is
history of congenital weekness of pelvic muscle weeknes.
9. delivery of big baby (in size)
CLASSIFICATION (on anatomy of prolaps)
Anterior vaginal wall—
Upper two third—cystocele
Lower one third—urethrocele
Posterior vaginal wall—
upper one third—enterocele
Lower two third—rectocele
cystocele
urethrocele
rectocele
enterocele
(on the base of degree of decent)
procidentia : all of the uterus outside the introitus
Signs & Symptoms
●
●
●
●
●
●
●
Something descending per vaginam
Low backache
Bleeding from decubitus ulcer
Discharge per vaginam
Imperfect control of micturition
Frequency of micturition
Difficulty in voiding
COMPLICATION
●
●
●
●
Decubitus ulcer
Obstructions in the urinary tract
Incarceration
elonhation of cervix
INVESTIGATION
1. history of some thing is commimg out of the vagina
2. Ass. the physical sign….ask the patient to cough , the patient will
complain of protrudation
3. by taking the patient concern the perineal body & levator muscle are
palpated. ( positive finding will be reduced tone of muscle)
4. for procidentia there is no need of any investigation (?)
5. some lab. investigation are done to conform the findings and serivity
of the prolaps
like
●
●
●
●
●
●
hb
xray
MRI
urethroscopy
vaginal swab to know the bacterial infection
all the investigation are mandatory prior to major surgery
DIFFERENTAL DIAGNOSIS
vulval cyst (tumor)
● cyst of ant. vaginal wall
● urethral diverticuli
● cervical fibroid polyp
●
management
Kegel exercise:
S-1: Get into a comfortable position. You can do these exercises either
sitting in a chair or lying on the floor. Make sure your buttock and tummy
muscles are relaxed. If you are lying down, then you should be flat on
your back with your arms at your sides and your knees up and together.
Keep your head down, too, to avoid straining your neck.
S-2 :Squeeze your pelvic floor muscles for five seconds. If five is even too
long for you, you can begin by squeezing those muscles for just 2-3
seconds.
S-3 :Release your muscles for ten seconds. Ideally, you should always
give those pelvic floor muscles a ten-second break before you repeat the
exercise. This gives them enough time to relax and to avoid strain.
Pessary
Vaginal pessaries are the only currently available non-surgical
intervention for managing women with prolapse
This may be temporary fitted in vagina.
Is made up of plastic or rubber. The 1st and 2nd degree prolaps can be
treated by this method .The only disadvantage is rectal irreatation and
microbial contanimation .
surgerycal management
1. viganal hysterectomy
2. abdominal sling operation
3. le forts repair
REFERANCES
text book of gynacology shaw, images form webmd, Dc datta
THANK YOU
any dout ?????