What Is a Prolapsed Uterus?
Uterine prolapse means that the uterus descends from the normal position along the vagina, the outer opening of the cervix is below the level of the sciatic spine, and even the uterus prolapses outside the vaginal opening, often with bulging anterior and / or posterior walls of the vagina. The anterior and posterior walls of the vagina are adjacent to the bladder and rectum, so uterine prolapse can also be accompanied by bladder urethra and rectal bulge. Uterine prolapse is related to the relaxation of the ligaments that support the uterus and the weakening of the pelvic floor. Therefore, it is more common in women who are prolific, malnourished, and physically laboring.
- nickname
- Uterine prolapse
- English name
- uterine prolapse
- Visiting department
- Gynecology
- Common locations
- uterus
- Common causes
- Caused by childbirth and supportive tissues not returning to normal after childbirth
- Common symptoms
- Abdominal fall, backache, increased leucorrhea, etc.
- Contagious
- no
Basic Information
Causes of Uterine Prolapse
- Birth injury
- Is the main cause of uterine prolapse. Childbirth, especially dystocia, prolonged second stage of labor, or vaginal surgery to assist delivery, can easily cause damage to the cervix, cervical main ligament, uterine sacral ligament, and pelvic floor muscles. If the supporting tissues fail to return to normal after delivery, uterine prolapse Down.
- 2. Increased abdominal pressure
- In the postpartum period, women are more prone to supine, and are prone to chronic urinary retention. The uterus tends to become posterior. The uterine axis is consistent with the vaginal axis. When the abdominal pressure increases, the uterus descends along the vaginal direction and prolapses. Chronic constipation and cough, ascites or abdominal obesity can increase abdominal pressure and promote uterine prolapse.
- 3. Congenital developmental abnormalities
- Uterine prolapse in the parturient women is caused by dysplasia of the supporting organs of the reproductive organs.
- 4. Malnutrition
- A severe lack of nutrition can lead to muscle atrophy, relaxation of the pelvic fascia, and loss of support for the uterus. Patients with uterine prolapse due to malnutrition are often accompanied by symptoms such as sagging stomach and lax abdominal wall.
- 5. Aging
- Ovarian dysfunction results in a decrease in estrogen secretion, making the pelvic floor supporting tissue weak and loose, prone to uterine prolapse, or exacerbating the original degree of prolapse.
Clinical manifestations of uterine prolapse
- The patient consciously fell in the abdomen, which was more pronounced when backache, walking and squatting. The prolapse in the vagina of mild prolapse patients can be self-contained after resting in the supine position. In severe cases, the prolapse cannot be accepted, which affects the action. Due to long-term exposure of the cervix, mucosal surface thickening, keratosis, or erosion and ulceration occur. Patients with increased leucorrhea, and sometimes pus-like or bloody, and some menstrual disorders, excessive menstrual blood. With bladder bulge, dysuria, urinary retention, and stress urinary incontinence may occur.
- Uterine prolapse is the displacement of the uterus down the vagina, which can be divided into 3 degrees according to the degree of prolapse:
- 1. degree
- The level of the external orifice of the cervix is lower than the level of the sciatic spine and does not reach the edge of the hymen. The cervix and uterine body are still located in the vagina. This degree of uterine prolapse does not require treatment, you can recover by paying attention to rest.
- 2. Degree
- It means that the cervix has come out of the vaginal opening while the uterus or part of the uterus is still inside the vagina. However, because the scope is too large, only the cervix prolapses out of the vaginal opening. In severe cases, the cervix is prolonged, so that the extended cervix and vaginal wall are prolapsed out of the vaginal opening.
- degree uterine prolapse is divided into light and heavy two types: degree mild cervical prolapse outside the vaginal opening , the uterine body is still inside the vagina. The cervix and part of the cervix and the anterior wall of the vagina were mostly or all prolapsed outside the vaginal opening.
- 3.degree
- Refers to the entire uterine body and cervix to prolapse outside the vaginal opening.
Uterine prolapse examination
- Instruct the patient not to urinate and take the bladder lithotomy position. During the examination, let the patient cough or hold his breath to increase the abdominal pressure, observe whether the urine overflows from the urethral orifice to determine whether there is tension urinary incontinence, and then empty the bladder for a gynecological examination.
- First pay attention to the situation of prolapse of the vaginal wall and uterine prolapse without force. Pay attention to the vulvar condition and the degree of perineal laceration.
- A vaginal speculum was used to observe whether the vaginal wall and cervix were ulcerated, and whether there was a uterine rectal fossa hernia. During the internal diagnosis, attention should be paid to the condition of the levator ani muscles on both sides, to determine the width of the levator ani muscle, the position of the cervix, and those with severe uterine prolapse. .
- Finally, the patient was instructed to use abdominal pressure, and if necessary, take a squatting position, and then perform a percussion to determine the degree of uterine prolapse.
Uterine prolapse diagnosis
- Diagnosis is based on symptoms, signs and pelvic examination. At the same time, it is necessary to determine whether it is combined with other surrounding organs bulging and whether there are complications.
Uterine prolapse treatment
- Since the operation has a certain impact on vaginal delivery again, the operation is only suitable for severe cases and women who no longer have children.
- Pessary treatment
- (1) Indications The pessary has long been used to treat uterine prolapse. It can enable patients to master it by themselves, but it is not suitable for severe uterine prolapse and excessive vaginal relaxation.
- (2) Model of pessary It is suitable to be slightly larger than the reproductive (pubic coccygeal) fissure. Generally, the transverse diameter of the fissure is 4 cm at most, so a medium-sized pessary is used. After a period of time, the pubic coccyx muscle gradually recovers its elasticity, and the tissue edema disappears after the prolapse is reset, and the weight is reduced, and the uterus can no longer prolapse.
- (3) Use time Generally, leave it in the morning before work, take it out at night, and wash it. The menstrual period is best not used. The surface of the plastic support is smooth, and it is not easy to deteriorate when encountering acid and alkali, and has little irritation to the tissue. After being put on board, the symptoms disappeared and he could participate in various labors without suffering.
- 2. Pelvic floor exercise
- Suitable for mild patients. The levator ani muscle exercise method is as follows: forcefully contract the anus, relax the pelvic floor muscles for more than 3 seconds, and continue for 10 to 15 minutes each time, 2 to 3 times a day.
- 3. Surgical treatment
- According to the etiology of the uterine prolapse, the severity of the disease, the presence of other surrounding organs, and fertility requirements, the appropriate surgical method is selected to achieve the purpose of restoring normal anatomy and function. Including shortening the loose main ligament to improve the support of the uterus; correcting abnormal morphology of the uterus, such as those with prolonged hypertrophy of the cervix, part of the cervix must be removed to restore the normal length of the cervix; shortening of the pubic bladder cervical fascia and strengthening the anterior vaginal wall Supporting force; suture the pubic coccyx muscle fissure and re-establish a well-functioning perineal body.
- 4. Notes
- (1) Take appropriate rest to avoid heavy physical labor
- (2) Avoid actions that increase abdominal pressure such as standing or squatting, holding your breath for a long time.
- (3) Keep the urination unobstructed.
- (4) Timely treatment of diseases that increase abdominal pressure such as chronic bronchitis.
- (5) Proper physical exercise to improve physical fitness.