Uterine prolapse occurs when the pelvic floor muscles and ligaments weaken, causing the uterus to descend into the vagina. It is common in post-menopausal women with a history of vaginal childbirth. Symptoms include feeling a bulge in the vagina, urinary incontinence, and pressure or pain in the pelvis. Management options include pelvic floor exercises, pessaries to support the uterus, and surgical procedures to repair damaged tissues or remove the uterus.

1. Prolapse of the
uterus

2. CONTENT
Introduction
Definition
Causes
Signs & symptoms
Types of prolapse
Degrees of prolapse
Diagnosis &
Investigations
Management

3. Introduction
• It is one of the common clinical condition met
in day to day gynecological practice.
• It is most often seen in multiparous women.
• It is a form of herniation.
• Uterine prolapse can happen to women of any
age , but it affects post menopausal women
who had one or more vaginal deliveries.
• The incidence of prolapse is about one in 250
pregnancies.
• Uterine prolapse occurs when pelvic floor
muscles and ligaments stretch and weaken,
providing inadequate support for the uterus.
The uterus then slips down into or protrudes
out of the vagina.
Weakening of the pelvic muscles that leads to
uterine prolapse can be caused by:
1) Damage to supportive tissue during pregnancy
and child birth.
2) Effects of gravity
3) Loss of estrogen
20XX presentation title 3

4. Support of the uterus
• Round
ligaments
• Broad
ligaments
• Pubocervical
ligaments
• Pelvic floor
muscles

5. Definition
20XX presentation title 5
•Uterine prolapse means the uterus has
descended from its normal position in
the pelvis farther down into the vagina.
•Uterine prolapse is a form of female
genital prolapse. It is also called pelvic
organ prolapse or prolapse of the uterus
(womb).

6. 20XX presentation title 6

7. 20XX presentation title 7
CAUSES
Your uterus is held in place within your pelvis by a group of muscles
and ligaments (pelvic floor muscles). When these structures weaken,
they become unable to hold your uterus in position and it begins to
sag. Several factors can contribute to the weakening of the pelvic
muscles, including:
•Vaginal delivery
•Age at first delivery (older women are at higher risk of pelvic floor injuries
compared with younger women)
•Difficult labor and delivery or trauma during childbirth
•Delivery of a large baby
•Being overweight
•Lower estrogen level after menopause
•Chronic constipation or straining with bowel movements
•Chronic cough or bronchitis
•Repeated heavy lifting

8. 20XX presentation title 8

9. Types of Prolapse
20XX 9
Vaginal vault prolapse
This is a condition where the upper walls of the vagina lose their normal shape, resulting in a collapse into the
vaginal canal or lower. This generally occurs when the muscles and tissues of the vagina and pelvis weaken, and
can happen after hysterectomy surgery or as a complication from other types of prolapse.
Uterine prolapse
When the pelvic muscles and ligaments stretch beyond the ability to support the uterus, a uterine prolapse is
likely. This causes the uterus to descend out of the vagina. This can happen as a result of complications from
pregnancy (trauma during childbirth or delivering a large baby, for example) as well as chronic constipation,
obesity, and repeated heavy lifting.
Bladder prolapse
Also known as an anterior or cystocele prolapse, this is what happens when the supportive tissue of the bladder
and vaginal wall weakens and bulges. The result is the bladder lowering into the vagina. Many of the same issues
that cause a uterine prolapse can also cause this condition.
Rectocele prolapse
A posterior vaginal (or rectocele) prolapse occurs when the thin wall of tissue that separates the rectum and
vagina weakens, causing the vaginal wall to bulge and descend. As with the other types of prolapse, obesity,
complications from childbirth, heavy lifting, and constipation are all common factors that contribute to this
condition.
Enterocele prolapse
This condition happens when the lower intestine descends into the lower pelvic cavity and pushes at the top of the
vagina. The resulting bulge is the result of most of the common issues with other prolapses.

10. 20XX presentation title 10

11. 20XX presentation title 11
Degrees of uterine prolapse
Uterine prolapse is described in stages, indicating how far it has
descended. Other pelvic organs (such as the bladder or bowel)
may also be prolapsed into the vagina.,. The four categories of
uterine prolapse are:
•Stage I – the uterus is in the upper half of the vagina
•Stage II – the uterus has descended nearly to the opening of
the vagina
•Stage III – the uterus protrudes out of the vagina
•Stage IV – the uterus is completely out of the vagina.

12. 20XX presentation title 12

13. 20XX presentation title 13

14. 20XX presentation title 14
oHematology
oRectal exam
oPelvic exam
oVaginal exam
oUSG
oX- RAY
oMRI
Investigation

15. 20XX presentation title 15
DIFFERENTIAL DIAGNOSIS
• Cystic swelling in the vagina
• Chronic inversion of the uterus
• Hypertrophy of the cervix
• All other causes of low backache and
urinary symptoms
• Virginities: congestion of the vagina in
case of severe virginities may give the
feeling of fullness of vagina.

16. 20XX presentation title 16
oUtero-vaginal prolapse may be
visible during inspection of the vulva.
oIn case of minor prolapse it may
become visible on straining.
oRectal examination also differentiate
between rectocele and enterocele.
Signs :

17. 20XX presentation title 17
• SEEING OR FEELING TISSUE BULGE OUT OF THE VAGINA
• FEELING HEAVINESS OR PULLING IN THE PELVIS
• FEELING LIKE THE BLADDER DOESN'T EMPTY ALL THE WAY WHEN YOU USE THE
BATHROOM
• PROBLEMS WITH LEAKING URINE, ALSO CALLED INCONTINENCE
• TROUBLE HAVING A BOWEL MOVEMENT AND NEEDING TO PRESS THE VAGINA WITH
YOUR FINGERS TO HELP HAVE A BOWEL MOVEMENT
• FEELING AS IF YOU'RE SITTING ON A SMALL BALL
• FEELING AS IF YOU HAVE VAGINAL TISSUE RUBBING ON CLOTHING
• PRESSURE OR DISCOMFORT IN THE PELVIS OR LOW BACK
• SEXUAL CONCERNS, SUCH AS FEELING AS THOUGH THE VAGINAL TISSUE IS LOOSE
Symptoms

18. 20XX presentation title 18
Urinary
incontinence
It can feel like a strong urge to go to the
restroom (known as urgency urinary
incontinence) or due to activities that put
pressure on the bladder (known as stress
urinary incontinence), like coughing,
laughing, sneezing, jumping, running, etc.
People who have these symptoms may end
up altering their daily routine, such as
visiting the bathroom more frequently to
avoid leaking, identifying all the restrooms
ahead of time in public places, drinking less
often so that they don’t need to pee as
often, wearing incontinence briefs or pads,
etc. For people who leak urine while
exercising or during intercourse, they might
simply stop doing those activities altogether.

19. 20XX presentation title 19
Management
The management of uterine prolapse is described
under the following headings:
1.Prevention
2.Physiotherapy
3.Pessary
4.Surgical treatment

20. 20XX presentation title 20
1. Prevention
Repeated childbirth with short intervals causes uterine vaginal collapse.
• Women should be advised to avoid pregnancies in quick succession
Labour
1st stage
• Avoid bearing down
• Breech or forceps delivery before full dilation of cervix shouldn’t be attempted
2nd stage
• Avoid prolongation of this stage
• Perform episiotomy if tears or overstretching of perineum is feared
3rd stage
• Avoid credes method
• Episiotomy or tears should be carefully sutured.
Puerperium
• Treat chronic cough and constipation
• Avoid strenuous exercises and standing for prolonged time

21. 20XX presentation title 21
2. Physiotherapy
• Early cases of UV prolapse are helped by
pelvic floor exercises particularly during
puerperium and while waiting to undergo
surgical treatment.
• Kegel exercises are used to tone up pelvic
musculature
These exercises are done 3 times a day for 20
mins each.

22. 20XX presentation title 22

23. 20XX presentation title 23

24. 20XX presentation title 24
3. Pessary treatment
• A mechanical device for correcting and
controlling UV prolapse
• A pessary does not cure UV prolapse
• It only holds the genital tract in position.
• Advised for patients who cannot
undergo surgery.
Types
1. Ring pessary
2. Hodge pessary
3. Gellhorn pessary
4. Doughnut pessary

25. 20XX presentation title 25

26. 20XX presentation title 26
Surgical Treatment
Surgical options
•Hysterectomy and prolapse repair: Uterine prolapse may be treated
by removing your uterus in a surgical procedure called a
hysterectomy. This may be done through a cut (incision) made in your
vagina (vaginal hysterectomy) or through your abdomen (abdominal
hysterectomy). Hysterectomy is major surgery, and removing your
uterus means pregnancy is no longer possible.
•Prolapse repair without hysterectomy: This procedure involves
putting your uterus back into its normal position. Uterine suspension
may be done by reattaching the pelvic ligaments to the lower part of
your uterus to hold it in place. The surgery can be done through your
vagina or through your abdomen depending on the technique your
provider uses.

27. 20XX presentation title 27
•Use stitches to fix weak pelvic floor structures. This can be done in a way that
keeps the depth and width of the vagina intact for sexual function.
•Close the opening of the vagina. This procedure is called a colpocleisis. It may
allow for an easier recovery from surgery. This surgery is only an option for those
who no longer want to use the vaginal canal for sexual activity.
•Place a piece of mesh to support vaginal tissues. In this procedure, vaginal
tissues are suspended from the tail bone using a synthetic mesh material.
All surgeries have risks. Risks of surgery for uterine prolapse include:
•Heavy bleeding
•Blood clots in the legs or lungs
•Infection
•A bad reaction to anesthesia
•Injury to other organs including the bladder, ureters or bowel
•Prolapse happens again
•Urinary incontinence

28. 20XX presentation title 28
References :
https://www.ncbi.nlm.nih.gov/books/NBK564
429/
https://my.clevelandclinic.org/health/disease
s/16030-uterine-prolapse
https://healthjade.net/pessary/
https://moonrise.health/blog/uterine-
prolapse-pictures/

29. thank you