Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Nov 29 2021

Uterine Prolapse

  • Snapshot
    • A 60-year-old, G6P6, Caucasion woman presents to her obstetrician after having a three day history of increased pelvic pressure and a "bulge" that is felt in her vagina when she coughs. Additionally, she has had a recent worsening of lower back pain.
  • SUmmary
    • Uterine prolapse occurs when pelvic floor musculature is unable to provide adequate support
      • ligaments can stretch and weaken over time
        • round ligament
        • ovarian ligament
        • broad ligament
        • uterosacral ligament
          • most important in preventing prolapse
  • Epidemiology
    • incidence
      • approximately 50% of women who have had children will develop organ prolapse
    • demographics
      • can affect women of any age
      • occurs most often in postmenopausal women
    • risk factors
      • trauma during child birth
      • multiple vaginal births
      • obesity
      • chronic coughing or straining
      • chronic constipation
    • Pathogenesis
      • incomplete prolapse
        • uterus drops part way down into the vagina
        • creates a bulge
      • complete prolapse
        • uterus slips down and protrudes out of the vagina
  • Presentation
    • Symptoms
      • heaviness or pressure in pelvis
      • pelvic pain
      • abdominal or lower back pain
      • dyspareunia
      • recurrent UTIs
      • urinary incontinence
      • symptoms worsened by prolonged standing or walking
        • added pressure on muscles by gravity
    • Physical exam
      • inspection
        • protrusion of tissue at opening of vagina (complete prolapse)
        • excessive vaginal discharge
  • Differential
    • Cystocele (bladder)
      • distinguishing factor
        • anterior vaginal prolapse
        • may present with difficulty starting urine stream, feeling of incomplete emptying of bladder, and frequency or urgency of urination
          • may also have leakage of urine (stress incontinence)
    • Rectocele
      • distinguishing factor
        • posterior vaginal prolapse
        • may present with posterior soft bulge, difficulty with bowel movements, senesation of rectal pressure, and not feeling that rectum has fully emptied after a bowel movement
  • Diagnosis
    • pelvic examination
    • palpation of bulges caused by uterus protruding into the vaginal canal
  • Treatment
    • Prevention
      • Weight
        • maintain healthy body weight
      • Exercise
        • regular physical activity
        • kegel exercises
      • Smoking cessation
        • prevents chronic cough
    • Conservative
      • Kegel exercises
        • indications
          • mild cases
        • mechanism
          • strengthen pelvic floor musculature
      • vaginal pessary
        • indications
          • mild to moderate
        • mechanism
          • rubber device that fits around the cervix to help hold the uterus in place
    • Operative
      • hysterectomy
        • indications
          • moderate to severe
        • mechanism
          • removal of uterus
      • sacrohysteropexy
        • indications
          • moderate to severe
        • mechanism
          • resuspension of the prolapsed uterus using a mesh sling
1 of 0
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options