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8/2/2019 Uterine Prolapse Submitted by Bharat Malhotra
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UTERINE
PROLAPSESUBMITTED BY-
BHARAT MALHOTRA
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Definition
Uterus (womb in which a fetus develops) is normally held
in place inside pelvis with various muscles, tissue, and
ligaments. Sometimes-because of childbirth or
difficult labor and delivery-these muscles weaken.
As a woman ages and with a natural loss of the hormone
estrogen, her uterus can collapse into the vaginal canal,
causing the condition known as a prolapsed uterus.
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Types Muscle weakness or relaxation may allow the uterus to
sag or come completely out of the body to a variable
extent. Prolapsed uterus can be described in the
following stages:
First degree: The cervix remains into the vagina.
Second degree: A descent of cervix in introitus, which
may protrude further on straining, with the possibility of
damage, infection & ulceration.
Third degree: (procidentia): The entire uterus descends
outside the introitus of body, causing total inversion of
vagina.
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Associated Conditions
Other conditions are usually associated with prolapsed uterus. Theyweaken the muscles that hold the uterus in place:
Cystocele: A herniation (or bulging) of the upper front vaginal wallwhere a part of bladder bulges into the vagina, which may lead to
urinary frequency, urgency, retention, and incontinence.
Enterocele: The herniation of the upper rear vaginal wall where asmall bowel portion bulges into the vagina. Standing leads to apulling sensation and backache and is relieved when lying down.
Rectocele: The herniation of the lower rear vaginal wall where therectum bulges into the vagina. This makes bowel movementsdifficult to the point that the woman may need to push on theinside of the vagina to empty the bowel.
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Who Gets Uterine Prolapse?
Uterine prolapse most often occurs in women who have
had more than one baby through normal vaginal delivery
and in post-menopausal women. Menopause occurs
when a woman's ovaries stop producing the hormones
that regulate her monthly menstrual cycle, and she stops
having regular menstrual periods. One of these
hormones, estrogen, helps keep the pelvic muscles
strong.
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Causes
The following conditions can cause a prolapsed uterus:
Pregnancy/multiple childbirths with normal or
complicated delivery through the vagina
Weakness in the pelvic muscles with advancing age
Weakening and loss of tissue tone after menopause and
loss of natural estrogen
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Conditions leading to increased pressure in the abdomen such as
chronic cough (with bronchitis and asthma), straining
(with constipation), pelvic tumors (rare), or an accumulation of fluid
in the abdomen
Being overweight or obese with its additional strain on pelvic
muscles
Major surgery in the pelvic area leading to loss of external support
Other risk factors include:
Excess weight lifting
Being Caucasian: Caucasian women more commonly affected;African Americans and Asians are affected less often.
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Symptoms Symptoms of a prolapsed uterus include:
A feeling of fullness or pressure in pelvis (may describe it
as a feeling of sitting on a small ball)
Low back pain
Feeling that something is coming out of vagina
Painful sexual intercourse
Difficulty with urination or moving your bowels
Difficult walkin
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Repeated bladder infections
Feeling of heaviness or pulling in the pelvis
Vaginal bleeding
Increased vaginal discharge
Many of the symptoms are worse when standing or
sitting for long periods of time.
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Diagnosis
If a woman experiences symptoms associated with
prolapse she should consult her doctor.
The doctor will take her medical history and then
perform a vaginal examination. A rectal examination mayalso be performed if a rectocele or enterocele is
suspected.
The woman may be asked to cough or push down during
the examination as this raises the pressure in theabdomen and pushes any prolapse downwards, making it
easier to see or feel.
Coughing or pushing down can also help identify any
associated stress incontinence.
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These examinations may also been conducted while the
woman is in a standing position.
The doctor will also carry out a thorough abdominal
examination to ensure there are no other pelvicproblems.
If a woman also has incontinence it may be necessary to
conduct other tests to fully investigate the cause/s of
this.
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Treatment
There are surgical and non-surgical options for treating
uterine prolapse. The treatment chosen will depend on
the severity of the condition, as well as the woman's
general health, age and desire to have children.
Treatment generally is effective for most women.
Treatment options include the following:
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Non-Surgical Options
Exercise Special exercises, called Kegel exercises, can
help strengthen the pelvic floor muscles. This may be the
only treatment needed in mild cases of uterine prolapse.
To do Kegel exercises, tighten your pelvic muscles as if
you are trying to hold back urine. Hold the muscles tight
for a few seconds and then release. Repeat 10 times. You
may do these exercises anywhere and at any time (up to
four times a day).
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Vaginal pessary A pessary is a rubber or plastic
doughnut-shaped device that fits around or under the
lower part of the uterus (cervix), helping to prop up the
uterus and hold it in place. A health care provider will fit
and insert the pessary, which must be cleaned frequently
and removed before sex.
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Estrogen replacement therapy (ERT) Taking estrogen
may help to limit further weakness of the muscles and
other connective tissues that support the uterus.
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Surgical Options
Hysterectomy Uterine prolapse may be treated by
removing the uterus in a surgical procedure called
hysterectomy. This may be done through an incision
made in the vagina (vaginal hysterectomy) or through the
abdomen (abdominal hysterectomy). Hysterectomy is
major surgery, and removing the uterus means
pregnancy is no longer possible.
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Uterine suspension This procedure involves putting the
uterus back into its normal position. This may be done by
reattaching the pelvic ligaments to the lower part of the
uterus to hold it in place. Another technique uses a
special material that acts like a sling to support the
uterus in its proper position. Recent advances include
performing this with minimally invasive techniques and
laparoscopically (through small band aid sized incisions)
that decrease post operative pain and speed recovery.
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Prognosis
Most women with mild uterine prolapse do not have
bothersome symptoms and don't need treatment.
Vaginal pessaries can be effective for many women with
uterine prolapse. Surgery usually provides excellent results, however, some
women may require treatment again in the future.
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Prevention While women have little control over some contributing
factors to prolapse (eg., having a long labour or giving
birth to a large infant), there are a number of other stepsthey can take to reduce their risk.
Perform pelvic floor exercises regularly, particularly
during pregnancy after childbirth and into menopause.
Avoid constipation and straining during a bladder and
bowel movement.
Treat the cause of any chronic cough (if it is smoking-
related seek assistance in quitting). Maintain a healthy weight.
Avoid lifting heavy objects frequently. If lifting heavy
objects, make sure to bend at the knees and keep the
back straight.
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THANK YOU!!