Pelvic organ prolapse

(Redirected from Uterine prolapse)

Background

Pelvic anatomy.
  • Definition: herniation of pelvic organs to or beyond vaginal walls

Risk Factors

  • Advancing Age
  • Multiparity
  • Obesity
  • Race: Latina + Caucasian Women higher risk than African American Women
  • Constipation
  • Connective Tissue Disorders
  • Chronic Cough

Types

  • Cystocele
    • Most common form of pelvic organ prolapse
    • Hernia of anterior vaginal wall + descent of bladder
  • Rectocele
    • Hernia of posterior vaginal segment + descent of rectum
  • Enterocele
    • Hernia of intestines to or through vaginal wall
  • Uterine/Vaginal Vault Prolapse
    • Descent of apex of vagina to lower vagina, hymen, or beyond introitus
    • Apex= uterus and cervix, cervix, or vaginal vault
    • Apical prolapse often associated with enterocele

Clinical Features

  • Severity may be related to position
    • Less noticeable in AM and supine
    • Worse as day progresses, upright, and active
  • Vaginal Bulge/Fullness
  • Vaginal Pressure
  • Urinary Dysfunction
    • Overactive bladder symptoms
    • Urgency
    • Urinary incontinence
    • Enuresis
  • Defecatory Dysfunction
    • Constipation
    • Incomplete emptying
    • Fecal urgency
    • Fecal incontinence
    • Obstructive symptoms- Straining or need for digital pressure to vagina in order to completely evacuate
  • Sexual Dysfunction
    • Reports of adverse effects or orgasm and sexual satisfaction
    • Dyspareunia
    • Avoidance of sexual activity due to fear of discomfort or embarrassment

Differential Diagnosis

Postmenopausal Pelvic Pain

Gynecologic

Gastrointestinal

Urologic

Evaluation

  • Clinical diagnosis

Management

Emergency Department

  • Look for signs of infection or skin breakdown if prolonged prolapse
  • Reduction may be as simple as pushing organ back inside
  • If difficult reduction due to edema
    • Provide analgesia, and place copious granulated sugar
    • Wait 15 minutes for edema to subside and re-attempt reduction
    • If reduction fails, consult Gynecology

Outpatient

Treatment includes:

  • Expectant management
  • Conservative (vaginal pessary, pelvic floor muscle exercises)
  • Surgical

Disposition

  • Discharge with outpatient Gynecology referral

See Also

References

  • Rogers, RG, Fashokun, TB. Pelvic organ prolapse in women: Epidemiology, risk factors, clinical manifestations, and management. In: Post T, ed. UpToDate; Waltham, MA.: UpToDate; 2020. www.uptodate.com. Accessed June 16, 2020