UTERINE PROLAPSE

DEFINITION
Uterine prolapse is the downward displacement of the uterus into the
vaginal canal.

STAGES
a)First degree uterine prolapse
In first degree uterine prolapse, the cervix rests in the lower part of
vagina
b)Second degree uterine prolapse
In the second degree uterine prolapse,the cervix drops at the vaginal
opening.
c)Third degree uterine prolapse
In the third degree the cervix is outside the vagina.
d)Fourth degree uterine prolapse
The entire uterus is outside the vagina. This condition is also called
procidentia. This is caused by weakness in all of the supporting a
ETIOLOGY
1)Pregnancy/child birth with normal or complicated delivery through the
vagina.
2) Weakening in the pelvic muscles with advancing age.
3)Weakening and loss of tissues tone after menopause and loss of natural
Oestrogen.
4)Conditions leading to increased pressure in the abdomen such as chronic
cough(with bronchitis and asthma),straining(with constipation),pelvic
tumors or accumulation of fluid in the abdomen. Being overweight or
obese with its additional strain on pelvic muscles.
5) Major surgery in the pelvic area leading to loss of external support.
6) Smoking
RISK FACTORS
a)Excess weight lifting
b)Being Caucasian
c)High BMI
d)Family history
e)Older age

PATHOPHYSIOLOGY
Weakness of pelvic diaphragm
↓
Descent of pelvic diaphragm
↓
Stress on the endopelvic connective supporting systems
↓
Increase in the intra abdominal pressure
↓
Uterine Prolapse
DIAGNOSIS
a)Pelvic Examination:The patient is asked to bear down as if having a bowel
movement.Bearing down helps to assess how far the uterus has slipped
into the vagina.
The patient is asked to tighten the pelvic muscles as if stopping a stream of
urine,this test helps to check the strength of muscles.
b)Imaging Studies
▪A pelvic floor Ultrasound
It is done to assess the degree of prolapse and the state of pelvic
floor muscles.This type of ultrasound involves the transducer.
▪CT scan
▪MRI´s also give a good look at kidneys and pelvic organs.
CLINICAL FEATURES
a)Feeling of fullness or pressure in pelvis(a feeling of sitting on a small
ball)
b)Low back pain
c)Feeling that something is coming out of vagina.
d)Painful sexual intercourse
e)Difficulty with urination or moving bowels
f)Discomfort in walking
g)Urinary leakage ,retention or bladder infections
h)Vaginal bleeding or increase in vaginal discharge.
PREVENTION
▪Reduce weight
▪Avoid constipation by eating a high fiber diet
▪Do kegal exercises to strengthen pelvic muscles
▪Avoid heavy lifting or straining
TREATMENT
▪Medical Therapy :
Patients with mild uterine prolapse may require only conservative
management.(i.e)only topical oestrogen.
▪Kegal exercise:
Self care measures like kegal exercises helps to strengthen the pelvic
muscles,losing weight and treating constipation.
▪Pessary:
A vaginal pessary is a plastic or rubber ring inserted into vagina to
support the bulging tissues.
SURGICAL MANAGEMENT
▪Repair of the weakend pelvic floor tissues:
The surgeon grafts own tissue,donor tissue or a synthetic material
onto weekened pelvic floor structures to support pelvic organs.
▪Hysterectomy:
In severe uterine prolapse, hysterectomy is recommended.
NURSING MANAGEMENT
Nursing management is based on the degree of prolapse,needs and
Problems identified.
Nursing Assessment
Nurses should assess the patient for complaints of lower abdominal
pain,decreased appetite,generalized weakness,difficulty in walking
because of uterine prolapse.
NURSING DIAGNOSIS
1)Acute pain in the lower abdomen related to displacement of pelvic organ
Secondary to third degree uterine prolapse.
2)Fatigue related to weakness secondary to uterine prolapse.
3)Activity intolerance related to lump in the vagina secondary to second
degree uterine prolapse.
4)Imbalanced nutrition less than body requirement related to discomfort
faced secondary to uterine prolapse.
5)Anxiety / fear / knowledge deficit regarding uterine prolapse.
6)Risk for infection,impaired skin integrity related to uterine prolapse.
NURSING INTERVENTION
▪Assisting the doctors in the insertion of pessaries, or plastic rings, pull
or more complex structures to prevent descent of the pelvic organs.
▪Provide adequate comfortable devices.
▪Advice the patients to change the pessaries every 3-4 months.
▪Teach the patients to maintain personal hygiene.
Advice the patient to take diet rich in iron and fibre.
EXPECTED OUTCOMES
▪The patient experiences improved daily activities.
▪Report any other complications`
▪Exhibit improved nutritional status by increased weight.
REFERENCES
▪Sakshi Arora Hans,Text book of Gynecology,Jaypee Publications,
9th edition page number125-127
▪Lewis´s Medical and Surgical Nursing, Elsevier Publications, Second South
Asian Edition , volume – 2, page number 1358
▪Brunner and Suddarth´s Text book of Medical and Surgical Nursing, Wolter
Kluwer Publications, South Asian Edition page numbers 1829,1877-1879
▪Net References
https://emedicine.medscape.com
https://www.webmd.com>women>guide