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Prolapse of Uterus 

 
General Info

Prolapse of the uterus refers to the downward displacement of the vagina and uterus. The word prolapse is derived from the latin 'procidere' which means with effect to fall. The uterus is held in position by adequate ligaments Besides, it has the support of the muscular structures of vagina and all other local tissues and muscles. Due to the laxity of support by muscles, tissue and ligaments, the uterus sags downwards.

 
Causes
 
There are several factors which contribute to the displacement of the uterus. These include
Continuous distension of the intestines with gas or excess food materials leading
   to constant downward pressure on the womb.
Chronic constipation leading to pressure from behind from an over-filled colon
Tight clothing especially tight corsets
Constant stooping, and a weakened condition of the internal muscles of the
   abdomen
Through lack of exercise and bodily weakness.
Some of the other important factors responsible for prolapse of the uterus are prolonged labour, an interference in the delivery by inexpert people, lack of proper rest and diet in post-pregnancy periods, repeated deliveries and stressful manual work. An increased weight of the womb, tumors of the uterus, traction of the uterus and surgical injuries can also lead to this disorder. Menopausal atrophy may also precipitate prolapse of uterus.
 
Symptoms
 
A woman suffering from prolapse of a uterus feels that something is coming down through the vagina. She feels a sense of fullness in the region of the bladder and rectum. Other symptoms include
Dragging discomfort in the lower abdomen
Low backache, heavy menses and milk vaginal discharge.
There is also an increase in the frequency of urination and the patient feels difficulty in total emptying of the bladder. There may also be a burning sensation due to infection. The woman may experience difficulty in passing stools and complete evacuation of bowels. These symptoms become more pronounced before and during menstruation. The condition may also result in difficulty in normal sexual intercourse and sometimes sterility.
Prevention
It is easier to prevent prolapse of uterus than cure it after its occurrence. The measures to prevent it should include good antenatal care in pregnancy, proper management and timely intervention during delivery, good postnatal care with proper rest, correct diet and appropriate exercise so as to strengthen the pelvic musculature.
 
Diagnosis
 
A pelvic examination (with the woman bending down) reveals protrusion of the cervix into the lower part of the vagina (mild prolapse), upto the vaginal opening (moderate prolapse), or protrusion of the entire uterus outside the vaginal opening (severe prolapse).
These signs are often accompanied by protrusion of the bladder and front wall of the vagina (cystocele) or rectum and back wall of the vagina (rectocele) into the vaginal space. The ovaries and bladder may also be positioned lower in the pelvis than usual.
In rare cases a mass may be noted on pelvic exam if a tumor is the cause of the prolapse.
 
Treatment
 
Treatment of displaced womb must consist mainly of a suitable diet and exercise. The diet should be so planned as should aim at building up the internal musculature of the body. Of course, any tendency towards tight lacing, constant stooping, and heavy lifting must be avoided. 
To begin with the patient should adopt an all-fruit diet for about five days. The bowel should be cleansed daily with a warm water enema.
After the all-fruit diet , the patient should gradually embark upon a well-balanced diet, based on three basic food groups, namely, (i) seeds, nuts and grains (ii) vegetables and (iii) fruits.
A hot Epsom salts bath is also beneficial in the treatment of prolapse of the uterus and should be undertaken twice a week. This bath is prepared by dissolving one or one and half kg. of Epsom-salt in an ordinary bath of hot water. The patient should remain immersed in the bath from ten to twenty minutes. This bath should be taken just before retiring to bed and care should be exercised not to get chilled afterwards. No soaps should be used with the bath as it will interfere with its beneficial effects. The alternate hot and cold hip bath are also useful and should be undertaken at night on alternate days.
Exercise
Exercises to strengthen the pelvic musculature are extremely useful in the treatment of prolapse of the uterus. Lying on a couch with the legs raised higher than the rest of the body is very helpful in relieving pain and discomfort from a displaced womb. This should be done from half an hour to an hour two or three times daily. The feet should be raised about eighteen inches by placing cushions under them. When this is not possible the patient can sit on a chair with a feet on another chair. The more this can be done during the day, the better will it be in every way. The patient should also perform other exercises aimed at strengthening the abdominal muscles. These exercises will help greatly in correcting the displacement of the uterus.
Women should always take precautions to space out their children. This will allow the genital issues to regain their strength and vitality and thereby prevent prolapse of the uterus.
 
More Info
 
Thickening of soft skin of prolapsed tissue, making it itchy and diseased.

Formation of ulcers on prolapsed tissue.
Formation of ulcers on prolapsed tissue.
Urinary tract infection.
 
FAQ
 

When is conservative treatment advised for prolapsed uterus?
This is advised in post natal cases where surgical treatment can't be given 3-4 months after delivery.
  
What is incarceration of prolapse?
When prolapse becomes irreducible due to edema and congestion it is called incarcerated prolapse.
 
Glossary
 
Interiotus - Vaginal orifice.
Orifice - Opening.
Hysterectomy - Surgical removal of uterus. 
Nulliparous - A condition when a woman has never given birth to a child. 
Atony - Loss of tone.
Ascite - Fluid collection.
Decubitus Ulcer - Ulcers formed on the body due to prolonged confinement to bed.

 
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