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1. Presented by: Urooj Tariq
Roll number: 87
UTEROVAGINA
L PROLAPSE

2. PELVIC ORGAN PROLAPSE
• Pelvic organ prolapse refers to the prolapse or drooping of any of the
pelvic floor organs, including the:
1. Bladder
2. Uterus
3. Vagina
4. Small bowel
5. Rectum

3. NORMAL PELVIC ANATOMY
• Uterovaginal prolapse is caused by failure of interaction between
levator ani muscles and ligaments and facias that support the pelvic
organs.
• The levator ani muscles are :
1. Pubococcygeus,
2. Iliococcygeus,
3. Puborectalis.
• Forms a bowl shaped muscle.

4. LEVELS OF SUPPORT
• There are three levels of supporting ligaments and fasia which work
together to provide a dynamic system to support uterus, vagina and
other organs.
1. Level 1 support by uterosacral ligament.
2. Level 2 support by fascia surrounding vagina.
3. Level 3 support by fascia surrounding posterior vaginal attached
caudally to perineal body.

5. LEVEL 1
• By uterosacral ligament.
• Defects 》 descent of uterus within vagina.
• Level 1 support remains critical even after
hysterectomy.
LEVEL 2
• Provided by fascia that surrounds the vagina both
anteriorly and posteriorly.
1. Pubocervical fascia (vagina and bladder)
2. Rectovaginal fascia (vagina and rectum)
• Defect 》 prolapse og vaginal wall into vagina lumen.
• Bladder/ rectum will prolapse due to facial
attachment.
LEVEL 3
• By fascia of posterior vagina which is attached caudally
to perineal body.
• Defects of perineal body leada to lower posterior
vaginal wall prolapse.
• Loss of perineal body increases vaginal lumen so leads
to anterior vaginal polapse as well.

6. Uterosacral ligament

8. RISK FACTORS
1. Child birth injury,
2. Congenital weakness of pelvjc
muscles,
3. Chronic cough/ chronic constipation,
4. Post-op prolapse,
5. Prolonged labour,
6. Genital tract atrophy,
7. Age,
8. Multiparity.

9. SYMPTOMS OF PELVIC ORGAN PROLAPSE
1. Sensation of vaginal bulge.
2. Heaviness /protrusion at or beyond introitus.
3. Dragging discomfort relieved by lying or
sitting.
4. Difficulty voiding / obstructed defecation.
5. Sensation of incomplete emptying of bladder.
6. Digitation 》 reductiom of prolapse with
fingers.
7. Urninary / fecal incontinence.
8. Vaginal bleeding.

10. TYPES OF PROLAPSE
Cystocele:
A prolapse of the bladder into the vagina, the most common condition
Urethrocele:
A prolapse of the urethra (the tube that carries urine)
Uterine prolapse
Vaginal vault prolapse: prolapse of the vagina
Enterocele:
Small bowel prolapse
Rectocele:
Rectum prolapse

12. CLINICAL ASSESSMENT
• History should elicit presenting symptoms and
severity,
• Associated symptoms: urinary , fecal or sexual.
• Clinical examination should be done in
lithotomy position with Sims speculum to assess
degree of descent.
• Prolapse is defined in 3 degrees of descent:
1. STAGE 1 : Prolapse does not reach hymen.
2. STAGE 2: Prolapse reaches hymen.
3. STAGE 3: When it reaches mostly out of
hymen.

13. TREATMENT

14. CONSERVATIVE TREATMENT
1. Pelvic floor muscle exercises.
2. Suppotive vaginal pessaries.
3. Conservative treatment of bowel and
urinary symptoms.
4. Vaginal pessaries.
• Ring pessaries.
• Shelf pessapessaries.
• Gelhorn pessaries.

15. SURGICAL TREATMENT
• Offered if conservative
treatment fails or patient
choses surgery.
• Procedure chosen depends on
which compartment is
affected, whether woman
wishes to retain her uterus,
and whether vagina or
abdominal route is chosen.

16. SURGERY
1. Hysterectomy,
2. Sacrospinous fixation,
3. Sacrocolpopexy,
4. Mesh repair.