UTERINE PROLAPSE

Uterine prolapse occurs when the womb (uterus) drops down and presses into the vaginal area.

Types of prolapse
Depending on which organ prolapse is broken down into:
Cystocele: bladder hovers in the front of the vaginal wall.
Rectocele: the rectum (the last part of the large intestine to reach the anus)
descends on vaginal backside.
Uterine prolapse in this case is the womb that sticking the neck down first and
then the uterine body.
Enterocele bowel loops herniate through the rear end of the vagina.
Vaginal vault prolapse: occurs in women who have their uterus removed
(hysterectomy). The vagina is a blind pouch, turns as if you put the upside
down, inside out.
Degree of prolapse
Depending on the severity of the prolapse, the gynecologist who examined the
woman at the examination table, cataloged prolapse within a 4-grade scale. To
each of them corresponds to a specific treatment:
Grade 1 or mild: slight drop inside the vagina.
Moderate grade 2: the drop reaches the entrance to the vagina.
Grade 3 or worse: prolapse beyond the entrance of the vagina, the woman
touched or bulk note perfectly while walking, especially during exertion.
Grade 4 or complete, the organ (bladder, uterus or rectum) are completely out,
even at rest.

Grades 1 and 2, if they cause discomfort, should be treated with physical

therapy and a change of (dietary for correction, for example, constipation,
weight loss, limit physical exertion ...) habits.
Grades 3 and 4 generally require surgery to be corrected, sometimes with
removal of the organ that is out in the case of the uterus, and other rebuilding
the defect with mesh placement to offset the weakened pelvic floor, replacing it
with synthetic material that makes again supporting tissue, as in the case of the
bladder or rectum.

Causes
Muscles, ligaments, and other structures hold the uterus in the pelvis. If these tissues are weak
or stretched, the uterus drops into the vaginal canal. This is called prolapse.
This condition is more common in women who have had one or more vaginal births.
Other things that can cause or lead to uterine prolapse include:
Normal aging
Lack of estrogen after menopause
Conditions that put pressure on the pelvic muscles, such as chronic cough and obesity
Pelvic tumor (rare)
Repeated straining to have a bowel movement due to long-term constipation can make the
problem worse.

Symptoms
Pressure or heaviness in the pelvis or vagina
Problems with sexual intercourse
Leaking urine or sudden urge to empty the bladder
Low backache
Uterus and cervix that bulge into the vaginal opening
Repeated bladder infections
Vaginal bleeding

 Increased vaginal discharge

Symptoms may be worse when you stand or sit for a long time. Exercise or lifting may also
make symptoms worse

Exams and Tests

Your health care provider will do a pelvic exam. You will be asked to bear down as if you are
trying to push out a baby. This shows how far your uterus has dropped.

Uterine prolapse is mild when the cervix drops into the lower part of the vagina.

Uterine prolapse is moderate when the cervix drops out of the vaginal opening.

Other things the pelvic exam may show are:

The bladder and front wall of the vagina are bulging into the vagina (cystocele).

The rectum and back wall of the vagina (rectocele) are bulging into the vagina.

The urethra and bladder are lower in the pelvis than usual.

Treatment
You do not need treatment unless you are bothered by the symptoms.
Many women will get treatment by the time the uterus drops to the opening of the vagina.
LIFESTYLE CHANGES
The following can help you control your symptoms:

Lose weight if you are obese.

Avoid heavy lifting or straining.

Get treated for a chronic cough. If you cough is due to smoking, try to quit.

VAGINAL PESSARY
Your doctor may recommend placing a rubber or plastic donut-shaped device, into the
vagina.This is called a pessary. This device holds the uterus in place.
The pessary may be used for short-term or long-term. The device is fitted for your vagina. Some
pessaries are similar to a diaphragm used for birth control.
Pessaries must be cleaned regularly. Sometimes they need to be cleaned by the doctor or
nurse. Many women can be taught how to insert, clean, and remove a pessary.

Side effects of pessaries include:

Foul smelling discharge from the vagina

Irritation of the lining of the vagina

Ulcers in the vagina

Problems with normal sexual intercourse

SURGERY
Surgery should not be done until the prolapse symptoms are worse than the risks of having
surgery. The type of surgery will depend on:

The severity of the prolapse

The womans plans for future pregnancies

The womans age, health, and other medical problems

The womans desire to retain vaginal function

There are some surgical procedures that can be done without removing the uterus, such as a
sacrospinous fixation. This procedure involves using nearby ligaments to support the uterus.
Other procedures are also available.
Often, a vaginal hysterectomy is used to correct uterine prolapse. Any sagging of the vaginal
walls, urethra, bladder, or rectum can be surgically corrected at the same time.

Possible Complications
Ulceration and infection of the cervix and vaginal walls may occur in severe cases of uterine
prolapse.
Urinary tract infections and other urinary symptoms may occur because of a
cystocele. Constipation andhemorrhoids may occur because of a rectocele.

Bibliografa:
http://www.onmeda.es/enfermedades/prolapso_uterino-tratamiento-1729-6.html
http://www.clinicadam.com/salud/5/001508.html
https://centradaenti.es/tipos-y-grados-de-prolapsos-genitales/