Uterine prolapse

Normally uterus reamins in anteverted and anteflexed position,held inside pelvics with various muscle, tissue, and ligament.
Because of pregnancy, childbirth or difficult labour and delivery,in some women these muscle weaken.
Also ,as a woman ages and with a natural loss of the hormones oestrogen, uterus can into the vaginal canal, causing the condition known as a prolapsed uterus or uterine prolapse.
Support of uterus-
A) Primary support of uterus
1) Mechanical support-
            Uterine Axis
            Angel of anteversion
             Angel of anteflexion
 2) Mechanical support
            Pelvic diaphragm
             Perineal body
             Urogenital diaphragm
3) Fibromuscular support
              Pubrocervical
              Transverse cervical ligament
               Uterosacral ligament
B) Secondary support of uterus
                Broad ligament
Cause of uterus prolapse-
 A) Acquired cause-
      Menopause
      Repeated vaginal birth
      Traumatic deliveries
      Faulty birth practice
      Precipitate labour
      Iatrogenic trauma in case of vaginal hysterotomy,vulvectomy
      Increase intra-abdominal pressure in COPD, Constipation, obesity
      Increase weight of uterus in cause of Fibroid or myohyperplasia
B) Congenital cause
      Spina bifida occulta
       Neurological disorders
       Congenital weakness of supporting structure.
Classification of prolapse:
1) Vaginal prolapse
   Anterior vaginal wall 
     Upper 2/3rd -Cystocoele/cystouretherocoele
     Lower 1/3rd- Ureterocele
   Posterior vaginal wall
    Upper 1/3rd- Enterocoele
    Middle 1/3rd- Rectocele
    Lower 1/3rd- Lax perineum
2) Uterine prolapse
A)Uterovaginal prolapse
       It is the prolpase of uterus, cervix and upper vagina and is commonest type. Cystocele occurs first followed by traction effect on cervix causing retroversion of the uterus.
B) Congenital or Nulliparous prolapse
      There is no cystocele.The uterus herniated down along with inverted upper vagina.
     It is due to Congenital weakness of the supporting structure.
Degree of Uterine prolapse-
1°- Descent cervix into vagina
2°-Descent of cervix up to the introitus
 3°-Descent of the cervix outside the introitus.
Symptoms-
1) patient feel something coming down or out.
2)Groin/back pain
3) Feeling of heaviness/pressure in pelvis which is
    .worse with standing and lifting
    . worse at the end of the day
    . relieved by lying down
4)Dysparenia
5) In cystocele-Dysuria , incomplete eraculation of urine, frequency and urgency of micturition,stress in continuance, retention of urine.
6)In Rectocele-Difficulty in passing stool.
7) Decubitus ulcer
8) Cancer of cervix or vagina is rarely seen.
9) Even in untreated cases of prolapse.
Management of prolapse
1)preventive measures-
Adequate antenatal and international care.
Adequate postnatal care
General measure
2) Conservative measure
Improvement of general measure.
Oestrogen replacement therapy in postmenopausal women.
Pelvic floor exercise.
Pessary treatment.
3) Conservative surgeries for gentile prolapse
Coporrhaphy
Fothergill's repair
Shirodkar's procedures
1) Abdominal sling operation
2) Shirodkar's abdominal sling operation
3) Khanna's Abdominal sling operation

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