Usually, prolapse is rated by degrees: rests in the lower First-degree prolapse: the cervix part of the vagina. Second-degree prolapse: the cervix is at the vaginal opening. Third-degrees prolapse: the uterus protrudes through the introitus.
Etiology Stretching of muscle and fibrous tissue. eg. Pregnancy and childbirth. Increased intra-abdominal pressure as a result of chronic coughing, lifting of heavy objects and obesity, place pressure on the pelvic floor. A constitutional predisposition to stretching of the ligaments as a response presumably to years in the erect position. Menopause and ageing increase the risk of prolapse. (The female hormone estrogen plays an important role in maintaining the strength of the pelvic floor).
Clinical Manifestation on a small ball Feeling like you are sitting Difficult or painful sexual intercourse Frequent urination or a sudden urge to empty the bladder Low backache Uterus and cervix that stick out through the vaginal opening Repeated bladder infections Feeling of heaviness or pulling in the pelvis Vaginal bleeding Increased vaginal discharge
Treatment Vaginal pessary: This device fits inside your vagina and holds youruterus in place. Used as temporary or permanent treatment,vaginal pessaries come in many shapes and sizes.
Treatment (cont.) Surgery: Several different types of surgery can be used totreat a severe genital prolapse. These proceduresinclude: • surgery to repair the tissue that supports the prolapsed organ • surgery to repair the tissue around the vagina • surgery to close the opening of the vagina • surgery to remove the womb (hysterectomy)
Collaborative Care preventive measures: Early visits to HC provider = early detection Teach Kegel’s exercises during PP period preoperative nursing care: Thorough explanation of procedure, expectation and effect on future sexual f(x) Laxative and cleansing edema (rectocele) – independently, at home a day prior procedure Perineal shave prescribed also Lithotomy position for surgery postop nursing care: Pt. is to void few hours after surgery; catheter if unable (after 6 hrs)