Prolapse of the uterus.pptx

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1. Prolapse of the uterus

2. CONTENT Introduction Definition Causes Signs & symptoms Types of prolapse Degrees of prolapse Diagnosis & Investigations Management

3. Introduction It is one of the common clinical condition met in day to day gynecological practice. It is most often seen in multiparous women. It is a form of herniation. Uterine prolapse can happen to women of any age , but it affects post menopausal women who had one or more vaginal deliveries. The incidence of prolapse is about one in 250 pregnancies. Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus. The uterus then slips down into or protrudes out of the vagina. Weakening of the pelvic muscles that leads to uterine prolapse can be caused by: Damage to supportive tissue during pregnancy and child birth. Effects of gravity Loss of estrogen 20XX presentation title 3

4. Support of the uterus Round ligaments Broad ligaments Pubocervical ligaments Pelvic floor muscles Utero sacral ligaments

5. Definition 20XX presentation title 5 Uterine prolapse means the uterus has descended from its normal position in the pelvis farther down into the vagina. Uterine prolapse is a form of female genital prolapse. It is also called pelvic organ prolapse or prolapse of the uterus (womb).

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7. 20XX presentation title 7 Causes Your uterus is held in place within your pelvis by a group of muscles and ligaments (pelvic floor muscles). When these structures weaken, they become unable to hold your uterus in position and it begins to sag. Several factors can contribute to the weakening of the pelvic muscles, including: Vaginal delivery Age at first delivery (older women are at higher risk of pelvic floor injuries compared with younger women) Difficult labor and delivery or trauma during childbirth Delivery of a large baby Being overweight Lower estrogen level after menopause Chronic constipation or straining with bowel movements Chronic cough or bronchitis Repeated heavy lifting

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9. Types of Prolapse 20XX 9 Vaginal vault prolapse This is a  condition  where the upper walls of the vagina lose their normal shape, resulting in a collapse into the vaginal canal or lower. This generally occurs when the muscles and tissues of the vagina and pelvis weaken, and can happen after hysterectomy surgery or as a complication from other types of prolapse. Uterine prolapse When the pelvic muscles and ligaments stretch beyond the ability to support the uterus, a  uterine prolapse  is likely. This causes the uterus to descend out of the vagina. This can happen as a result of complications from pregnancy (trauma during childbirth or delivering a large baby, for example) as well as chronic constipation, obesity, and repeated heavy lifting. Bladder prolapse Also  known as  an anterior or cystocele prolapse, this is what happens when the supportive tissue of the bladder and vaginal wall weakens and bulges. The result is the bladder lowering into the vagina. Many of the same issues that cause a uterine prolapse can also cause this condition. Rectocele prolapse A  posterior vaginal  (or rectocele) prolapse occurs when the thin wall of tissue that separates the rectum and vagina weakens, causing the vaginal wall to bulge and descend. As with the other types of prolapse, obesity, complications from childbirth, heavy lifting, and constipation are all common factors that contribute to this condition. Enterocele prolapse This condition happens when the lower intestine descends into the lower pelvic cavity and pushes at the top of the vagina. The resulting bulge is the result of most of the common issues with other prolapses.

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11. 20XX presentation title 11 Degrees of uterine prolapse Uterine prolapse is described in stages, indicating how far it has descended. Other pelvic organs (such as the bladder or bowel) may also be prolapsed into the vagina.,. The four categories of uterine prolapse are: 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.

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14. 20XX presentation title 14 Hematology Rectal exam Pelvic exam Vaginal exam USG X- RAY MRI Investigation

15. 20XX presentation title 15 DIFFERENTIAL DIAGNOSIS Cystic swelling in the vagina Chronic inversion of the uterus Hypertrophy of the cervix All other causes of low backache and urinary symptoms Virginities: congestion of the vagina in case of severe virginities may give the feeling of fullness of vagina .

16. 20XX presentation title 16 Utero-vaginal prolapse may be visible during inspection of the vulva. In case of minor prolapse it may become visible on straining. Rectal examination also differentiate between rectocele and enterocele. Signs :

17. 20XX presentation title 17 Seeing or feeling tissue bulge out of the vagina Feeling heaviness or pulling in the pelvis Feeling like the bladder doesn't empty all the way when you use the bathroom Problems with leaking urine, also called incontinence Trouble having a bowel movement and needing to press the vagina with your fingers to help have a bowel movement Feeling as if you're sitting on a small ball Feeling as if you have vaginal tissue rubbing on clothing Pressure or discomfort in the pelvis or low back Sexual concerns, such as feeling as though the vaginal tissue is loose Symptoms

18. 20XX presentation title 18 Urinary incontinence It can feel like a strong urge to go to the restroom (known as urgency urinary incontinence) or due to activities that put pressure on the bladder (known as stress urinary incontinence), like coughing, laughing, sneezing, jumping, running, etc. People who have these symptoms may end up altering their daily routine, such as visiting the bathroom more frequently to avoid leaking, identifying all the restrooms ahead of time in public places, drinking less often so that they don’t need to pee as often, wearing incontinence briefs or pads, etc. For people who leak urine while exercising or during intercourse, they might simply stop doing those activities altogether.

19. 20XX presentation title 19 Management The management of uterine prolapse is described under the following headings: Prevention Physiotherapy Pessary Surgical treatment

20. 20XX presentation title 20 1. Prevention Repeated childbirth with short intervals causes uterine vaginal collapse. Women should be advised to avoid pregnancies in quick succession Labour 1 st stage Avoid bearing down Breech or forceps delivery before full dilation of cervix shouldn’t be attempted 2 nd stage Avoid prolongation of this stage Perform episiotomy if tears or overstretching of perineum is feared 3 rd stage Avoid credes method Episiotomy or tears should be carefully sutured. Puerperium Treat chronic cough and constipation Avoid strenuous exercises and standing for prolonged time

21. 20XX presentation title 21 2 . Physiotherapy Early cases of UV prolapse are helped by pelvic floor exercises particularly during puerperium and while waiting to undergo surgical treatment. Kegel exercises are used to tone up pelvic musculature These exercises are done 3 times a day for 20 mins each.

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24. 20XX presentation title 24 3. Pessary treatment A mechanical device for correcting and controlling UV prolapse A pessary does not cure UV prolapse It only holds the genital tract in position. Advised for patients who cannot undergo surgery. Types Ring pessary Hodge pessary Gellhorn pessary Doughnut pessary

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26. 20XX presentation title 26 Surgical Treatment Surgical options Hysterectomy  and prolapse repair: Uterine prolapse may be treated by removing your uterus in a surgical procedure called a hysterectomy. This may be done through a cut (incision) made in your vagina (vaginal hysterectomy) or through your abdomen (abdominal hysterectomy). Hysterectomy is major surgery, and removing your uterus means pregnancy is no longer possible. Prolapse repair without hysterectomy : This procedure involves putting your uterus back into its normal position. Uterine suspension may be done by reattaching the pelvic ligaments to the lower part of your uterus to hold it in place. The surgery can be done through your vagina or through your abdomen depending on the technique your provider uses.

27. 20XX presentation title 27 Use stitches to fix weak pelvic floor structures.  This can be done in a way that keeps the depth and width of the vagina intact for sexual function. Close the opening of the vagina.  This procedure is called a colpocleisis . It may allow for an easier recovery from surgery. This surgery is only an option for those who no longer want to use the vaginal canal for sexual activity. Place a piece of mesh to support vaginal tissues.  In this procedure, vaginal tissues are suspended from the tail bone using a synthetic mesh material. All surgeries have risks. Risks of surgery for uterine prolapse include: Heavy bleeding Blood clots in the legs or lungs Infection A bad reaction to anesthesia Injury to other organs including the bladder, ureters or bowel Prolapse happens again Urinary incontinence

28. 20XX presentation title 28 References : https://www.ncbi.nlm.nih.gov/books/NBK564429/ https://my.clevelandclinic.org/health/diseases/16030-uterine-prolapse https://healthjade.net/pessary/ https://moonrise.health/blog/uterine-prolapse-pictures/

29. thank you