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Prepared by:
Ms. Mayuri Patel

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Uterine Prolapse is the downward displacement
of the uterus into the vaginal canal or a gradually
descends of the uterus in the axis of the vagina taking
the vaginal wall with it.
Definition

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Supports conveniently grouped under
three tier system
1. UPPER TIER
 Endopelvic fascia covering the uterus
 Round ligaments
 Broad ligaments with intervening
pelvic cellular tissues
Support of the uterus

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 Cervico vaginal junction
• Fibromuscular tissue surrounding the vessels and
nerves this is important direct support of the uterus.
 Pelvic cellular tissues
• In this connective tissue and smooth muscles .
• The blood vessels and nerve supply to uterus,
bladder and vagina pass through it from the lateral
pelvic wall.
• The pelvic cellular tissue condense surrounding
them and give direct support
Middle tier

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• This condensation of the tissues surrounding the
supravaginal cervix and vagina down to the superior
layer of the fascia covering the levator ani constitute
a tough endopelvic facia covering the cervico vaginal
junction.
• It condenced and reinforced by plain muscles to
form ligaments – mackendrot’s, uterosacral and
pubocervical.
3. INFERIOR TIER
Musculofacial tone of the hollow vagina by the facial
condensation at the vault and by the pelvic floor.

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 Positional support to the anterior wall
 Pelvic floor tissue
• Strong condensation of pelvic floor tissue
• Below – posterior urethral ligament.
• Laterally – pubocervical ligament
 Bladder
 Support of posterior vaginal wall
• Endopelvic fascial sheath covering the vagina and
rectum
• Uterosacral ligament to lateral wall of the vault
• Levator ani with its facial covering
Support of vagina

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Predisposing factors
Acquired
Vaginal delivery with consequent
injury to the supporting structure
 overstretching of the mackenrodt’s
and uterosacral ligament.
overstretching of the perineum
subinvolution of the supporting
structure
Etiology

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

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congenital
Congenital weakness of the supporting
structures is responsible for the
nulliparous prolase
•short vagina
•increased paravaginal tissue laxity
•occult spina bifida associated with
neurological abnormalities

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postmenopausal atrophy
increased increases intra abdominal
presser as in chronic cough&
constipation
increased weight of the uterus as in
fibroid or myohyperplasia
asthenia & undernutrition
traction by anterior vaginal wall or
cervical polyp
Aggravating factors

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Clinical types

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Vaginal prolapse
1.Anteriorwall:
cystocele: formed by
laxity & descent the
2/3 rd of anterior
vaginal wall as the
bladder is closely
related to the area,
there is herniation of
the bladder through
the lax anterior wall.

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Urethrocele
formed by laxity &
descent the 1/3 rd
of lower anterior
vaginal wall as the
urethra is closely
related to the area,
there is herniation
of the urethra
thorough the lax
anterior wall

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Posterior wall
Relaxed perineum
Torn perineal
body protrudes
gaping introitus
with the buldge
of the lower
part of the
posterior wall.
Rectocele

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Primary
Enterocele: formed by laxity of the
upper 1/3 rd of posterior wall.,
there is herniation of the pouch of
Douglas through the lax wall, may
contain omentum or gut hence
called enterocele.
Secondary:
May occur following either vaginal or
abdominal hysterectomy
Vault prolaps

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Uterovaginal:
This is the commonest type. cystocele
occurs first by traction effect on the
cervix causing retroversion of the
uterus. Intra abdominal presser has got
piston like effect on the uterus thereby
pushing it down into vagina.
Congenital:
There is no cystocele. the uterus
descends down along with the inverted
upper vagina often seen in nulliparous.
Uterine prolaps

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First degree: The cervix droops into
the vagina. The uterus descends
down from its normal
position(external os at the level of
the ischial spine)but external os
still remains inside the vagina.
Degree of uterine prolaps

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Second degree
The external os protrudes out the
vaginal introitus but the uterine
body still remains inside the
vagina. The cervix sticks to the
opening of the vagina.

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Third degree
The uterine body descends to lie
outside the inroitus. The cervix
is outside the vagina.

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 Minor prolapse of the uterus may not cause any
problems
More severe prolapse can cause:
• Increased vaginal discharge.
• Feeling that something is coming out of the vagina
• Dragging sensation in the lower abdomen and back.
If cystocele is present, symptoms include:
• Difficulty in starting and stopping urination, Urinary
frequency.
• A feeling that the bladder needs emptying again soon after
urination
• Problems controlling the bladder.
• Frequent urinary infections may result if the bladder never
empties properly.
SIGNS & SYMPTOMS

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If Rectocele is present, symptoms include:
 Difficulty emptying the bowel, in spite of a constant feeling
that the rectum is full and needs to be emptied.
 Constipation can become a problem.
Some common Symptoms of Uterine Prolapse:
 Difficult or painful sexual intercourse
 Low backache.
 Feeling of rectal fullness.
 Constipation.
 Sensation of heaviness or pulling in the pelvis.
 Vaginal discharge
 Frequent urinary tract infections.
 Sensation of fullness in the vagina.
 Protrusion of pink tissue from the vagina that may be irritated
or itchy.

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PREVENTIVE
CONSERVATIVE
SURGERY
TREATMENT

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EFFECTIVE ANTENATAL CARE:
 -nutritional supplements, antenatal hygiene &
physiotherapy with relaxation exercises
INTRANATAL CARE:
 to prevent premature bearing down efforts
 to prevent premature application of forceps before the
cervix is fully dilated
 to avoid prolonged 2nd stage
 to avoid too much fundal pressure to expel out the
placenta
 to perform timely & adequate episiotomy
 to repair the perineal injuries immediate & accurately.
Preventive

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POSTNATAL CARE:
 -to prevent undue distension of bladder
 -to encourage early ambulance
 -to encourage the pelvic floor exercises
GENERAL MEASURES:
 -to avoid the strenuous activities 6 months following
delivery
 -to avoid future pregnancy too soon

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1. assurance:
2. improvement in nutritional status
3.Exercise
Special exercises, called Kegel exercises, can help
strengthen the pelvic floor muscles.
4. Vaginal pessary
Concervative

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1. Anterior colporraphy
 Correct cystocele and urethrocele.
 To exercise a portion of the relaxed anterior
vaginal wall to mobilize the bladder push it
upwards after cutting the vesico-vaginal
ligaments.
Surgery

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2. Colpoperineorraphy
To repair the prolaps of posterior vaginal wall.
It repair torn perineal body
Tightening of the pararectal facia.
3. Pelvic floor repair
4. fortergill’s operation
Preliminary dilatation and curratge
Amputation of the cervix
Palication of the mackenrodt’s ligament in front
of the cervix.
Anterior colporrhaphy
Colpoperineorrhaphy
5. Vaginal hysterectomy

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Thanks You!