Uterine Prolapse
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Definition/Description[edit | edit source]
Uterine prolapse is the condition of the uterus collapsing, falling down, or downward displacement of the uterus with relation to the vagina.1 It is also defined as the bulging of the uterus into the vagina.2 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 rectus.2
Uterine prolapse is characterized under a more general classification called pelvic organ prolapse which encompasses descent of anterior, middle and posterior structures into the vagina.3 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.2,3 The uterus and the vaginal vault which is the apex of the vagina can prolapse after a hysterectomy make up the organs that constitute the middle portion descent into the vagina.3 The rectum which is called a rectocele, part of the intestine and peritoneum are called a enterocele make up the posterior portion of pelvic organ prolapse.2,3 This information from this point forward will focus on uterine prolapse. Uterine prolapse is a result of pelvic floor relaxation or structural overstretching of the muscles of the pelvic wall and ligamentous structures.2 Uterine prolapse is classified using a four part grading system. A grade one is classified as a descent of the uterus to above the hymen. A grade two is a descent of the uterus to the hymen. A grade three is a descent of the uterus beyond the hymen and a grade four is total prolapse.3
Prevalence[edit | edit source]
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 parous women though most women are asymptomotic.3 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.4 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.5
Characteristics/Clinical Presentation[edit | edit source]
The primary symptoms of a uterine prolapse are backache, perineal pain, and a sense of "heaviness" in the vaginal area.2 Pain associated with uterine prolapse can be located centrally, suprpubic, and dragging in the groin. This pain is due to stretching of the ligamentous supports and secondarily to abrasion of the prolapsed tissues.1 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 membran of the cervix and vagina. This is possble 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.2
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[edit | edit source]
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Medications[edit | edit source]
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Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
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Causes[edit | edit source]
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.2 Associated risk also axists with pelvic tumors and neurologic condition like spina bifida and diabetic neuropathy which interfrers with innervation of pelvic musculature.2
Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports[edit | edit source]
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References[edit | edit source]
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