2. What is Uterine Prolapse ?
Pathophysiology.
Causes.
Clinical Manifestations.
Assessment and Diagnostic Findings.
Medical Management.
Nursing Management.
◦ Nursing Assessment.
◦ Nursing Diagnoses.
◦ Nursing Care Planning and Goals.
◦ Nursing Interventions.
◦ Evaluation.
◦ Documentation Guidelines.
3. Uterine prolapse occurs when the muscles and
tissue in your pelvis weaken. This allows your
uterus to drop down into your vagina. Common
symptoms include leakage of urine, fullness in
your pelvis, bulging in your vagina, lower-back
pain, and constipation.
4. Uterine prolapse is the herniation of the uterus
from its natural anatomical location into the
vaginal canal, through the hymen, or through the
introitus of the vagina. This is due to the
weakening of its surrounding support
structures. Uterine prolapse is one of the multiple
conditions that are classified under the broader
term of pelvic organ prolapse.
5. In its usual state, the uterus rests in the apical
compartment of pelvic organs. The uterus and
vagina are suspended from the sacrum and lateral
pelvic sidewall via the uterosacral and cardinal
ligament complexes. The weakening of these
ligaments allows for the prolapse of the uterus into the
vaginal vault.
Although uterine prolapse is not inherently life-
threatening, it can lead to sexual dysfunction, poor
body image, and lower quality of life due to
associated bowel or bladder incontinence.
6. Upon diagnosis, patients should be reassured that
uterine prolapse is a common and well-known
condition.
Additionally, educating patients regarding
potential sequelae and available treatments will
allow them to know what to expect and make
them active participants in their own care.
7. The risk factors for uterine prolapse are the same as
for other pelvic organ prolapses.
The Oxford Family Planning Association study
found that pelvic organ prolapse became more
likely with successive births.
Women with BMI >25 were more likely to
experience uterine prolapse than women with BMI
in the normal range.
Advancing age has been shown to correlate
markedly with rates of prolapse.
8. Additional risk factors include connective tissue
disorder such as Marfan syndrome and Ehler;’s
Danlos syndrome.
Congenital factors likely play a role in determining
facial strength, elasticity and resistance to trauma.
Some women may have inherently weak endo
pelvic fascia and therefore be at an increased risk of
developing prolapsed and stress incontinence.
Acquired factors play a major role.
The feeling of a lump in the vagina, drugging
sensation low backache.
9. Bleeding and or discharge from the ulceration
Voiding difficulty which may occur with a
large cystocele and urethral kinking.
Incomplete bowel emptying from a rectocele.
Some women need to digitally replace the
prolapsed in order to defecate and micturate
10. It is difficult to distinguish rates of uterine
prolapse from pelvic organ prolapse as most
studies cohort them together.
Approximately 50% of women in the US can be
expected to have some degree of pelvic organ
prolapse in advanced age ( affects 9.7% of women
between ages 20-39 and 49.7% of women >80
years old).
11. In less developed countries such as Nepal, greater
than 1 million women out of approximately 15
million women have been found to have uterine
prolapse, equating to approximately 7% of the
Nepalese female population.
12. Image 3: Uterosacral ligament
The symptoms of uterine prolapse include:
a sensation of heaviness and pressure in the
vagina
a distinct lump or bulge within the vagina
a bulge protruding out of the vagina
painful sexual intercourse.
13. Uterine prolapse is described in 4 stages, indicating
how far it has descended. Other pelvic organs (such
as the bladder or bowel) may also be prolapsed into
the vagina.
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.
14. Treatment of uterine prolapse is largely
dependent on the extent to which a patient is
experiencing symptoms. Treatments include
surgical and non-surgical options, the choice of
which will depend on general health, the severity
of the condition and plans for a future pregnancy.
15. Pathyphysiology Usually caused by obstetric
trauma
↓ Over stretching of muscular fasial supports
↓ Uterus herniates through pelvic floor
↓ Protrudes into vagina (prolapse)
↓ Possibly beyond the introitus (procidental)
16.
17. Proper diagnosis and management of uterine
prolapse can majorly impact a patient’s quality of
life and can have long-term physical and mental
health effects. Healthcare practitioners should
thoroughly counsel patients with uterine prolapse
so they can make informed decisions and choose
the treatment that is right for them[1].
Options include:
18. Pelvic floor exercises
Vaginal pessary
Vaginal surgery.
Pelvic floor muscle training:
Typically taught to patients in association with a
physiotherapist. They have been shown to result in
subjective improvement in symptoms by patients as
well as objective improvement in the The Pelvic
Organ Prolapse Quantification (POP-Q) system
score by examiners.
19. Objects often made of silicone that are inserted into
the vagina to provide support for the prolapsed
pelvic organs.
Vaginal pessaries can be an effective way of
reducing the symptoms of a prolapse, but they will
not be appropriate for everyone. Together with
pelvic floor exercises, they may provide a non-
surgical solution to manage a uterine prolapse.
Vaginal pessaries provide a solution in 84% of cases
of advanced pelvic organ prolapse with mild
adverse events in 31% of cases.
20.
21.
22. Patients must be fitted for a pessary and
commonly try several pessaries before finding the
appropriate one. The examiner should be able to
sweep a single finger between the pessary and
vaginal walls. The patient should be able to walk,
bend, and urinate comfortably without shifting
the pessary. Complications of pessary placement
include vaginal irritation/ulceration, discharge,
pain, bleeding, and odor.
23. Regular reassessments of pessary fit should be
performed to ensure that the pessary is not
rubbing against the walls of the vagina, as this can
lead to irritation of the vaginal mucosa and
predispose patients to infection. Patients with
dementia or poor follow up are not good
candidates for pessary placement as they require
frequent cleaning and regular reassessment of
position to prevent complications.
24. Decision should be made after a detailed discussion
with the patient regarding the desire for future
vaginal intercourse, effects on body image, cultural
views, alternative treatments, and potential
complications.
In moderate to severe cases, the prolapse may have to
be surgically repaired. In laparoscopic surgery,
instruments are inserted through the navel.
The uterus is pulled back into its correct position and
reattached to its supporting ligaments. The operation
can also be performed with an abdominal incision.
25. Surgery may fail and the prolapse can recur if the
original cause of the prolapse, such as obesity,
coughing or straining, is not addressed
26. Physical therapists play a major role in the
nonsurgical management of Uterine prolapse.
Along with pessary support, pelvic-floor muscle
training (PFMT) is cited in highly credible reviews
as a main nonsurgical option for women with
Uterine prolapse.
See the great physiotherapy section in Pelvic Organ
Prolapse.
Complications
27. The weakness of pelvic floor attachments allowing
for prolapse of the apical compartment can
additionally allow for prolapse of the anterior and
posterior compartments resulting in a compounded
cystocele, rectocele, and/or enterocele. These often
concomitant conditions can result in urinary
incontinence, fecal incontinence, and long term
morbidity. In addition to physical discomfort, it is
common for patients to experience anxiety,
depression, and poor self-esteem as a result of their
condition thus, referral for psychotherapy should be
offered.
28. Treatment for uterine prolapse includes lifestyle
changes, a pessary, or surgery to remove the
uterus.
You may be able to prevent this condition with
weight loss, a high fiber diet, not smoking, and
doing Kegel exercises.
Pelvic floor muscle exercise or functional bracing
against increases in vitra abdominal pressure may
reduce symptoms of prolapsed.
Pessaries are plastic rings, balls or more complex
structures that are inserted vaginally to prevent
descent of the pelvic organs.
29. Special exercises, called Kegel exercises, can
help strengthen the pelvic floor muscles. This
may be the only treatment needed in mild
cases of uterine prolapse.
To do Kegel exercises, tighten your pelvic
muscles as if you are trying to hold back urine.
Hold the muscles tight for a few seconds and
then release. Repeat 10 times. You may do
these exercises anywhere and at any time (up
to four times a day).
30.
31. Hysterectomy and prolapse repair.
Uterine prolapse may be treated by removing
the uterus in a surgical procedure called a
hysterectomy.
This may be done through a cut (incision) made
in the vagina (vaginal hysterectomy) or through
the abdomen (abdominal hysterectomy).
Hysterectomy is major surgery, and removing
the uterus means pregnancy is no longer
possible.
32. Prolapse repair without hysterectomy: This
procedure involves putting the uterus back
into its normal position. Uterine suspension
may be done by reattaching the pelvic
ligaments to the lower part of the uterus to
hold it in place.
The surgery can be done through the vagina
or through the abdomen depending on the
technique that is used.
33. Maintaining a healthy body weight.
Exercising regularly. In addition, do Kegel exercises
to strengthen your pelvic floor muscles.
Remember, check with your healthcare provider
before starting any new exercise program.
Eating a healthy diet. Talk to your healthcare
provider or a nutritionist (a special type of
healthcare provider who helps you form a meal
plan) about the best diet for you.
Stop smoking. This reduces the risk of developing
a chronic cough, which can put extra strain on the
pelvic muscles.
Using proper lifting techniques.
34. Uterine Prolapse (Post Operative)
Assessment
Subjective Data:
Pain in the area of operation.
Tired.
Dizzy.
Nausea, bloating.
Objective Data :
There is a wound in the groin.
Fasting.
Mucous membranes dry mouth.
35. Acute pain related to the surgical wound.
Risk for fluid volume deficit related to vomiting
after surgery.
Impaired skin integrity related to the surgical
wound.
Risk for hypertermia related to surgical wound
infection.
Knowledge deficit: surgical wound care related
to lack of information
36. 1. Acute pain related to the surgical wound.
Goal: Pain disappeared after the act of
nursing.
Expected outcomes:
Pain is reduced gradually.
37. 1. Acute pain related to the surgical wound.
Goal: Pain disappeared after the act of nursing.
Expected outcomes:
Pain is reduced gradually.
Interventions:
Assess the patient's pain intensity.
Observation of vital signs and patient complaints.
Place the patient on a bed with a technique that is appropriate to the surgery
performed.
Give the sleeping position that is fun and safe.
Instruct the patient to immediately move gradually.
Give appropriate analgesic therapy medical program.
Take action with the child nursing care.
Teach relaxation techniques.
38. 2. Risk for fluid volume deficit related to
vomiting after surgery.
Goal: There is no shortage of fluid volume.
Expected outcomes:
Elastic skin turgor, not dry,
No nausea and vomiting.
39. Observation of vital signs every 4 hours.
Monitor the infusion.
Give drink and eat gradually.
Monitor for signs of dehydration.
Monitor and record the fluid in and out.
Measure body weight per day.
Record and inform the doctor about vomiting.
40. 3. Impaired skin integrity related to the
surgical wound.
Goal: Damage to skin integrity is resolved.
Expected outcomes:
The surgical wound is clean, dry, no swelling.
no bleeding.
41. Observation of the state of the surgical wound
of signs of inflammation: fever, redness,
swelling and discharge.
Treat the wound with sterile technique.
Keep around the surgical wound.
Give nutritious foods and encourage patients to
eat.
Involve the family to keep the clan surgical
wound environment.
Teach family in the care of the surgical wound.
42. 4. Risk for hypertermia related to surgical
wound infection.
Goal: Hyperthermia is resolved.
Expected outcomes:
The surgical wound is clean, dry, not swollen.
no bleeding.
The temperature in the normal range (36-37 °
C).
43. Observation of vital signs every 4 hours.
Give appropriate antibiotic therapy medical
program.
Give a warm compress.
Monitor the infusion.
Ambulatory surgical wound with sterile
technique.
Keep the surgical wound.
Monitor and record the fluid in and out.
44. 5. Knowledge deficit: surgical wound care
related to lack of information.
Goal: The client knows how to take care of the
surgical wound.
Expected outcomes:
Parents understand the operation wound care.
Parents can maintain cleanliness and surgical
wound treatment.
45. Teach parents how to care for the surgical
wound and keep it clean.
Discuss about the wishes of the family
wanted to know.Allow the patient's family to
ask.
Explain about the care of patients at home,
do not wet and dirty bandage.
Suggest to continue treatment / take
medication regularly at home, and control
back to the doctor.
46. Obtain pain relief.
Patients receive adequate fluid intake volume.
Improved patient skin integrity.
Good skin turgor.
The client's body temperature within normal
limits.
Gain knowledge about uterine prolapse and
treatment program.
Mentions how the surgical wound care is good
and right.
