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<div class="noeditbox">Welcome to [[Pathophysiology of Complex Patient Problems|PT 635 Pathophysiology of Complex Patient Problems]] This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div><div class="editorbox">
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'''Original Editors '''- [[Pathophysiology of Complex Patient Problems|Amanda Mattingly from Bellarmine University's&nbsp;Pathophysiology of Complex Patient Problems project.]]  
 
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== Definition/Description  ==
== Definition/Description  ==
[[File:Uterine Prolapse diagram.png|right|frameless|400x400px]]
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|pelvic organ prolapse]].
* In its usual state, the uterus rests in the apical compartment of pelvic organs. The [[Female Genital Tract|uterus and vagina]] are suspended from the [[sacrum]] and lateral pelvic sidewall via the [[The Uterine And Cervical Ligaments|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.<ref name=":0">Chen CJ, Thompson H. [https://www.statpearls.com/ArticleLibrary/viewarticle/30897 Uterine Prolapse]. StatPearls [Internet]. 2020 Nov 19.Available from:https://www.statpearls.com/ArticleLibrary/viewarticle/30897 (accessed 4.4.2021)</ref>.<ref name="three">Bordman R, Telner D, Jackson B, Little D. Step-by-step approach to managing pelvic organ prolapse. Canadian Family Physician; 2007; 53: 485-487.</ref> <ref name="twentyone">Mater Mothers' Hospital. Prolapse. http://brochures.mater.org.au/Home/Brochures/Mater-Mothers--Hospitals/Prolapse (accessed 5 April 2010).</ref>
* 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<ref name=":0" />.
[[File:Uterus and nearby organs.jpeg|right|frameless|350x350px]]


[[Image:Uterine Prolapse.jpg|frame]]Uterine prolapse is the condition of the uterus collapsing, falling down, or downward displacement of the uterus with relation to the vagina.<ref name="one">Goodman CC, Snyder TEK. Differential Diagnosis for Physical Therapists. 4th ed. St. Louis: Saunders Elsevier, 2007.</ref> It is also defined as the bulging of the uterus into the vagina.<ref name="two">Goodman CC, Fuller KS. Pathology: Implications for the Physical Therapist. 3rd ed. St. Louis: Saunders Elsevier, 2009</ref>
== Etiology ==
 
The risk factors for uterine prolapse are the same as for other pelvic organ prolapses.  
&nbsp;
* The Oxford Family Planning Association study found that pelvic organ prolapse became more likely with successive births. 
 
* Women with [[Obesity|BMI >25]] were more likely to experience uterine prolapse than women with BMI in the normal range. 
[[Image:Pelvic floor.jpg|left]]
* [[Older People - An Introduction|Advancing age]] has been shown to correlate markedly with rates of prolapse. 
 
* Additional risk factors include [[Connective Tissue Disorders|connective tissue disorder]]<nowiki/>s such as [[Marfan Syndrome|Marfan]] syndrome and [[Ehlers-Danlos Syndrome|Ehler’s Danlos]] syndrome<ref name=":0" />
<br>
 
<br>
 
<br>
 
<br>
 
When in proper alignment, the uterus and the adjacent structures are suspended in the proper position by the uterosacral, round, broad, and cardinal ligaments. The musculature of the pelvic floor forms a sling-like structure that supports the uterus, vagina, urinary bladder, and rectum.<ref name="two" />&nbsp;Uterine prolapse is a result of pelvic floor relaxation or structural overstretching of the muscles of the pelvic wall and ligamentous structures.
 
[[Image:Different prolapse.jpg|thumb|right]]<br>
 
<br>
 
'''Uterine prolapse is characterized under a more general classification called pelvic organ prolapse which encompasses descent of the&nbsp;anterior, middle and posterior structures into the vagina'''.<ref name="three">Bordman R, Telner D, Jackson B, Little D. Step-by-step approach to managing pelvic organ prolapse. Canadian Family Physician; 2007; 53: 485-487.</ref>
 
*Those organs that bulge anterior into the vagina are the urinary bladder which is called a cystocele, the urethra which is called a urthrocele or a combination which is a cystourethrocele.<ref name="two" />,<ref name="three" />
*The uterus and the vaginal vault, which is the apex of the vagina that can&nbsp;prolapse after a hysterectomy, make up the organs that constitute the middle portion descent into the vagina.<ref name="three" />
*The rectal buldge is called a rectocele and a bulge of&nbsp;part of the intestine and peritoneum are called a enterocele, these&nbsp;make up the posterior portion of pelvic organ prolapse.<ref name="two" />,<ref name="three" /> The information from this point forward will focus on uterine prolapse.
 
<br>
 
<br>'''Uterine prolapse is classified using a four part grading system:'''
 
Grade&nbsp;1:&nbsp;Descent of the uterus to above the hymen
 
Grade&nbsp;2:&nbsp;Descent of the uterus to the hymen
 
Grade&nbsp;3:&nbsp;Descent of the uterus beyond the hymen
 
Grade&nbsp;4:&nbsp;Total prolapse.<ref name="three" /> <br>
 
== Prevalence  ==
 
Each source presents with a differing prevalence depending on the researcher and the population used. One study stated that the prevalence of pelvic organ prolapse, a clinical classification for all of the pelvic structures prolapse into the vagina, was 50% for women who have give birth,&nbsp;though most women are asymptomotic.<ref name="three" /> Another article cited that 50% of the female population in the United States are affected by pelvic order prolapse with a prevalence rate that can vary from 30% to 93% varying among different populations.<ref name="four">Kudish BI, Iglesia CB, Sokol RJ, Cochrane B, Richter HE, Larson J, et al. Effect of weight change on natural history of pelvic organ prolapse. Obstet Gynecol 2009; 113: 81-88.</ref> A questionnaire based study stated that 46.8% of the responses were positive to signs of pelvic organ prolapse and of the response group, 46.9% were vaginally examined with 21% having clinically relevant pelvic organ prolapse.<ref name="five">Hove MC, Pool-Goudzwaard AL, Eijkemans MJC, Steegers-Theunissen RPM, Burger CW, Vierhout ME. Prediction model and prognositc index to estimate clinically relevant pelvic organ prolapse ina general female population. Int Urogynecol J 2009; 20: 1013-1021.</ref>
 
== Characteristics/Clinical Presentation  ==
 
The primary symptoms of a uterine prolapse are backache, perineal pain, and a sense of "heaviness" in the vaginal area.<ref name="two" /> Pain associated with uterine prolapse can be located centrally, suprapubic, and dragging in the groin. This pain is due to stretching of the ligamentous supports and secondarily to abrasion of the prolapsed tissues.<ref name="one" /> If the prolapse has progressed into a grade three or third degree prolapse, the person may feel as though they have a lump at the vaginal opening and have irritation and abrasion of the exposed mucous membrane of the cervix and vagina. This is possible both during sexual intercourse and from wiping with toileting procedures. The person may report that the symptoms are relieved by lying down and exacerbated with prolonged standing, walking, coughing or straining. An associated complication of uterine prolapse is urinary incontienice.<ref name="two" /> Summary from Differnetial
 
'''Diagnosis for Physical Therapists''':
 
*Lump in vaginal opening
*Pelvic discomfort, backache
*Abdominal cramping
*Symptoms relieved by lying down
*Symptoms made worse by prolonged standing, walking, coughing, or straining
*Urinary incontinence
 
== Associated Co-morbidities  ==
 
Obesity is a co-morbidity that often leads to progression and complication with uterine prolapse. In a study by the NIH, over a five year period 55.7% of the women in the study gained weight and the rate of prolapse increased from 40.9% to 43.8%. Looking specifically at uterine prolapse, when comparing participants with healthy BMI’s to overweight and obese persons, the risk of prolapse increased by 43% and 69% respectively. However, the loss of weight did not presuppose a reversal of the uterine prolapse.<ref name="four" />
 
== Medications  ==
 
Hormone replacement therapy in the oral or vaginal form are indicated or a possible treatment to assist in maintaining elasticity of the pelvic floor musculature.<ref name="two" /><ref name="three" />
 
== Diagnostic Tests/Lab Tests/Lab Values  ==
 
Observation is often the first means of diagnosis.<ref name="two" /> Physical examination is the primary means for diagnosis. A bimanual test is performed with a speculum while the person is at rest and when the person is straining. If prolapse is not apparent with the first method, the person repeats the test while standing with one foot on a chair. The person is then graded using a first through third degree categorization. A first degree prolapse is characterized by descent of the uterus to above the hymen. A second degree prolapse is to the level of the hymen and a fourth degree prolapse is below the level of the hymen and protrudes through the vaginal opening.<ref name="two" /> Urine culture is ordered if a needed. If still unsure about the diagnosis, a pelvic ultrasonography or cystography can be ordered.<ref name="three" />
 
== Causes  ==
 
Women most at risk for this condition are those who have had multiple pragnancies and deliveries in combination with obesity. Assosciated risk factors are trama to the pudendal or sacral nerves when giving birth. The disorder has been attributed to prlonged labor, bearing down before full, dialation, and forceful delivery of the palcenta. Decreased muslc tone due to aging, excessive strain during bowen movment and complications of pelvic surgery have also been associated with prolapse of the uterus and adjacent organs.<ref name="two" /> Associated risk also axists with pelvic tumors and neurologic condition like spina bifida and diabetic neuropathy which interfrers with innervation of pelvic musculature.<ref name="two" /><br>
 
== Systemic Involvement  ==
 
The digestive system can be impacted by uterine prolapse if the uterus obstructs the bladder/urethra and the rectum from voiding.<ref name="six">Hove MC, Pool-Goudzwaard Al, Eijkemans MJC, Steegers-Theunissen RPM, Burger CW, Vierhout ME. The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population. Int Urogynecol J 2009; 20:1037-1045.</ref> The reproductive system can also be impacted by painful intercourse, decreasing the ability for reproduction.<ref name="one" />
 
== Medical Management (current best evidence)  ==
 
Corrective surgery was a once popular first step but it has fallen second choice to rehabilitation. When surgery is indicated, it is a management tool for second and third-degree uterine prolapse.<ref name="two" /> Pelvic organ prolapse surgery has a success rate of 65% to 90% and has a repreated rate of operation at 30%. Patients who have more than one compartment involved may need a combination of surgeries and can often predispose patients ot prolapse in another compartment. Surgery can be both open or laproscopic of the abdomen or can be in the vagina using fasciae, mesh, tape or sutures to suspend the organs. Another surgical procedure that is used in attempt to conserve the uterus is a sacrohysteropexy which is a Y-shaped graft that attaches the uterus to the sacrum.<ref name="three" /> One case study that examined the effectiveness in laparoscopic sacrohysteropexy, stated that this procedure “maintains durable anatomic restoration, normal vaginal axis and sexual function.” It also requires less time and less adhesion formation due to laparospocia approach versus an abdominal route.<ref name="seven">Faraj R, Broome J. Laparoscopic sacrohysteropexy and myomectomy for uterine prolapse: a case report and review of the literature. Journal of Medical Case Reports 2009; 3: 99-102.</ref> Vaginal hysterectomy, vesicourethral suspension, and abdominal hysterectomy are other possible approaches.<ref name="two" /> A pessary can be considered which is a shaped device made to support the uterus in the vagina. There is a supportive type for milder prolapse and a space-occupying type for more serious prolapse. The goal of the pessary is to find the largest fit that is comfortable. They are to be re moved regularly for cleaning by the individual with correct education or by a health care professional.<ref name="three" />
 
== Physical Therapy Management (current best evidence)  ==
 
Pelvic floor strengthening exercise is currently front line treatment before surgical option and also following surgery, these include but are not limited to Kegel exercises.<ref name="two" /><ref name="three" /> Other methods currently used are reeducation, postural education, biofeedback and electrical stimulation.<ref name="two" /><br>Education on positions of irritation and management of pain during exercise program and during sexual intercourse with gravity assisted positions. Supine with a pillow or wedge support under the pelvis can be useful position for rest, pelvic floor exercise performance and during intercourse.<ref name="one" />&nbsp;<br>&nbsp;
 
== Alternative/Holistic Management (current best evidence)  ==
 
Methods considered in association to pelvic floor muscle strengthening are weight loss for preventative measures, smoking cessation and treatment of constipation.<ref name="three" /> Other suggestions from another source suggest adequate hydration, fiber intake, developing regular bowel habits, regular exercise, and hormone replacement therapy.<ref name="two" />
 
== Differential Diagnosis  ==
 
add text here


== Case Reports ==
== Epidemiology ==


add links to case studies here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br>
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).
* 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<ref name=":0" />


== Resources <br> ==
== Clinical Presentation  ==
Image 3: Uterosacral ligament
[[File:Uterosacral ligament.png|right|frameless]]
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.
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<ref name=":1">Vic Health [https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/prolapsed-uterus#treatments-for-uterine-prolapse Uterus Prolapse] Available from:https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/prolapsed-uterus#treatments-for-uterine-prolapse (accessed 4.4.2021)</ref>.


add appropriate resources here
== Treatment/Management  ==
[[File:Pelvic-floor-muscles hammock.jpg|right|frameless|500x500px]]
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.


== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
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<ref name=":0" />.


see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]]
Options include:
<div class="researchbox">
* Pelvic floor exercises
<rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1BOJ2J2KKlLDU4InWGbRCc7YMJP63DBKmJ-usz8oZ6308F1UdI!!|charset=UTF-8|short|max=10</rss>
* Vaginal pessary
</div>
* Vaginal surgery.<ref name=":1" />
# 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.
[[File:Pessary.png|right|frameless|696x696px]]
2. Vaginal pessaries:
* 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. 
* 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.
* 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.
3. Surgical management
* 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.
* Surgery may fail and the prolapse can recur if the original cause of the prolapse, such as obesity, coughing or straining, is not addressed<ref name=":1" /><ref name=":0" />.   


== References  ==
== Physiotherapy ==
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.<ref>Saunders K. [https://academic.oup.com/ptj/article/97/4/455/3057463 Recent advances in understanding pelvic-floor tissue of women with and without pelvic organ prolapse: considerations for physical therapists.] Physical therapy. 2017 Feb 28;97(4):455-63. Available from:https://academic.oup.com/ptj/article/97/4/455/3057463 (last accessed 11.1.2020)</ref>


see [[Adding References|adding references tutorial]].
See the great physiotherapy section in [[Pelvic Organ Prolapse]]


<references />
== Complications ==
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<ref name=":0" />.<article>
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<ref name=":0" />.
==References  ==
<references />  


[[Category:Womens_Health]]
[[Category:Pelvic Health]]
[[Category:Pelvis]]
[[Category:Pelvis - Conditions]]
[[Category:Conditions]]
[[Category:Bellarmine_Student_Project]]
[[Category:Bellarmine_Student_Project]]

Latest revision as of 19:12, 4 April 2021

Original Editors - Amanda Mattingly from Bellarmine University's Pathophysiology of Complex Patient Problems project. Top Contributors - Amanda Mattingly, Admin, Lucinda hampton, Kim Jackson, WikiSysop, Oyemi Sillo, Nicole Hills, 127.0.0.1, Elaine Lonnemann and Wendy Walker  

Definition/Description[edit | edit source]

Uterine Prolapse diagram.png

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.

  • 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.[1].[2] [3]
  • 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[1].
Uterus and nearby organs.jpeg

Etiology[edit | edit source]

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. 
  • Additional risk factors include connective tissue disorders such as Marfan syndrome and Ehler’s Danlos syndrome[1]

Epidemiology[edit | edit source]

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).
  • 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[1]

Clinical Presentation[edit | edit source]

Image 3: Uterosacral ligament

Uterosacral ligament.png

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.

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[4].

Treatment/Management[edit | edit source]

Pelvic-floor-muscles hammock.jpg

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.

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:

  • Pelvic floor exercises
  • Vaginal pessary
  • Vaginal surgery.[4]
  1. 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.
Pessary.png

2. Vaginal pessaries:

  • 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. 
  • 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.
  • 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.

3. Surgical management

  • 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.
  • Surgery may fail and the prolapse can recur if the original cause of the prolapse, such as obesity, coughing or straining, is not addressed[4][1].

Physiotherapy[edit | edit source]

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.[5]

See the great physiotherapy section in Pelvic Organ Prolapse

Complications[edit | edit source]

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[1].<article> 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[1].

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Chen CJ, Thompson H. Uterine Prolapse. StatPearls [Internet]. 2020 Nov 19.Available from:https://www.statpearls.com/ArticleLibrary/viewarticle/30897 (accessed 4.4.2021)
  2. ↑ Bordman R, Telner D, Jackson B, Little D. Step-by-step approach to managing pelvic organ prolapse. Canadian Family Physician; 2007; 53: 485-487.
  3. ↑ Mater Mothers' Hospital. Prolapse. http://brochures.mater.org.au/Home/Brochures/Mater-Mothers--Hospitals/Prolapse (accessed 5 April 2010).
  4. ↑ 4.0 4.1 4.2 Vic Health Uterus Prolapse Available from:https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/prolapsed-uterus#treatments-for-uterine-prolapse (accessed 4.4.2021)
  5. ↑ Saunders K. Recent advances in understanding pelvic-floor tissue of women with and without pelvic organ prolapse: considerations for physical therapists. Physical therapy. 2017 Feb 28;97(4):455-63. Available from:https://academic.oup.com/ptj/article/97/4/455/3057463 (last accessed 11.1.2020)
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