Uterine Prolapse
Name: M. Mubeen Amjad
Class: GBSN-02
Semester: lll
Roll no: 21
Subject: Adult Health Nursing
Uterine Prolapse: Objectives
• Introduction to Uterine Prolapse
• Prevalence of Uterine Prolapse
• Relevant Anatomy in Uterine Prolapse
• Types of Uterine Prolapse
• Risk Factors for Uterine Prolapse
• Causes of Uterine Prolapse
• Signs and Symptoms
• Pathophysiology of Uterine Prolapse
• Medical Management
• Surgical Management
• Nursing Management
• Nutritional Management
• Complications of Uterine Prolapse
• Summary and Conclusion
Introduction to Uterine Prolapse
• Pelvic Support Integrity Loss: Uterine prolapse arises
from compromised pelvic muscles and ligaments that
normally maintain uterine position.
• Postmenopausal Vulnerability: Reduced estrogen
postmenopause precipitates connective tissue
weakening, increasing prolapse susceptibility
markedly in elderly women.
• Common Pelvic Organ Prolapse: Among pelvic organ
prolapses, uterine prolapse predominates in women,
especially following multiple vaginal deliveries and
aging.
Prevalence of Uterine Prolapse
• Global Prevalence Variation: Global uterine prolapse
prevalence ranges from 3% to 50%, influenced by diagnostic
criteria and demographics.
• Higher Incidence in Older Women: Incidence markedly
increases in women over 60 due to cumulative pelvic floor
stress and menopausal estrogen decline.
• Impact of Socioeconomic Factors: Developing countries show
higher prevalence owing to limited obstetric care and higher
multiparity rates.
Relevant Anatomy in Uterine Prolapse
• Pelvic Floor Muscles: Levator ani and coccygeus muscles form
the pelvic diaphragm providing critical uterine and vaginal
support.
• Uterosacral and Cardinal Ligaments: These ligaments anchor
the uterus to sacrum and lateral pelvic walls, maintaining
uterine position against gravity.
• Vaginal Canal Structure: Vaginal walls are muscular and
elastic, contiguous with uterus, their integrity crucial to
preventing uterine descent.
Types of Uterine Prolapse
• Degree Classifications: First degree prolapse
involves mild uterine descent within the vaginal
canal without reaching introitus.
• Second and Third Degree: Second degree
prolapse extends to the vaginal opening, third
degree protrudes beyond introitus externally.
• Complete vs. Incomplete Prolapse: Complete
prolapse includes full uterine protrusion, while
incomplete prolapse features partial descent
without full exteriorization.
Risk Factors for Uterine Prolapse
• Multiparity and Vaginal Deliveries: Repeated vaginal births
cause pelvic floor muscle stretching, increasing uterine
support structure weakening risk.
• Aging and Menopausal Decline: Age-related collagen
degradation and estrogen deficiency diminish ligamentous
strength, heightening prolapse susceptibility.
• Additional Contributors: Obesity, chronic cough, constipation,
pelvic surgeries, genetic predisposition, and heavy lifting
exacerbate intra-abdominal pressure and tissue strain.
Causes of Uterine Prolapse
• Childbirth-Related Trauma: Vaginal deliveries cause
mechanical stretching and tearing of pelvic muscles and
ligaments essential to uterine support.
• Hormonal Influence on Ligaments: Declining estrogen
decreases collagen synthesis, weakening uterine ligaments
and compromising structural integrity.
• Increased Intra-Abdominal Pressure: Chronic coughing,
obesity, and heavy lifting elevate pressure against pelvic floor,
promoting uterine descent.
Signs and Symptoms
• Pelvic Pressure Sensation: Patients frequently
report a persistent sensation of pelvic heaviness or
pressure exacerbated by prolonged standing.
• Vaginal Bulge Protrusion: Visible or palpable
vaginal protrusion occurs as uterine descent
progresses, often causing discomfort and hygiene
issues.
• Urinary and Defecatory Dysfunction: Symptoms
include stress urinary incontinence, urgency,
hesitancy, and difficulty with bowel movements
due to anatomical distortion.
Pathophysiology of Uterine Prolapse
• Pelvic Support Disruption: Damage to pelvic muscles and
ligaments compromises uterine suspension causing
progressive descent through vaginal canal.
• Collagen Matrix Degradation: Reduction in collagen quantity
and quality weakens connective tissue framework critical for
maintaining uterine position.
• Muscle Atrophy Contribution: Pelvic floor muscle wasting
diminishes support strength, exacerbating uterine prolapse
severity and progression over time.
Medical Management
• Pelvic Floor Exercises: Regular kegel exercises strengthen
levator ani muscles, enhancing pelvic support and reducing
prolapse progression risk.
• Pessary Use: Pessaries provide mechanical support internally,
alleviating symptoms and postponing or avoiding surgical
intervention effectively.
• Hormone Replacement Therapy: Estrogen therapy improves
vaginal mucosa integrity and ligament strength, mitigating
postmenopausal prolapse worsening mechanisms.
Surgical Management
• Vaginal Hysterectomy: Removes uterus via vagina,
suitable for severe prolapse when uterine preservation
isn't preferred or possible.
• Uterine Suspension Techniques: Repositions uterus
using native ligaments or mesh, preserving uterus
especially for women desiring future fertility.
• Sacrospinous Fixation and Sacrocolpopexy:
Sacrospinous fixation anchors vaginal apex to
ligament; sacrocolpopexy uses abdominal mesh for
durable correction.
Nursing Management
• Patient Education on Pelvic Exercises: Teach consistent pelvic
floor exercises to strengthen muscles, enhance support, and
prevent prolapse progression.
• Pessary Care Guidance: Instruct patients on pessary insertion,
removal, hygiene, and regular monitoring to prevent
infections and complications.
• Post-Operative Care and Support: Monitor wound healing,
manage pain, detect early complications, and provide
psychological support post-surgery for recovery.
Nutritional Management
• High-Fiber Diet Importance: Diet rich in fiber ensures regular
bowel movements, preventing constipation that elevates
intra-abdominal pressure.
• Adequate Hydration Role: Proper fluid intake maintains stool
softness, facilitating easy defecation and reducing strain on
pelvic floor tissues.
• Balanced Nutrition Benefits: Sufficient proteins, vitamins, and
minerals support collagen synthesis and tissue repair critical
for pelvic floor integrity.
Complications of Uterine Prolapse
• Ulceration and Infection: Prolonged exposure of
protruding uterine tissue causes mucosal ulceration,
predisposing to secondary infections and inflammation.
• Urinary Retention Risks: Mechanical obstruction or kinking
of urethra from prolapse leads to incomplete bladder
emptying and urinary retention issues.
• Recurrent Urinary Tract Infections: Residual urine
promotes bacterial growth, increasing frequency of
recurrent urinary tract infections and related morbidity.
Summary and Conclusion
• Comprehensive Risk Profile: Multiparity, advancing age,
menopause, and lifestyle factors collectively exacerbate
uterine support structure degradation.
• Varied Management Strategies: Combining conservative,
surgical, and supportive interventions individualized per
severity optimizes patient-specific uterine prolapse outcomes.
• Early Diagnosis & Multidisciplinary Care: Timely detection
and coordinated clinical teamwork enhance prognosis, reduce
complications, and improve quality of life significantly.
Thanks!
Any Questions ?
