Uterine prolapse
| Female genital prolapse | |
|---|---|
Uterine prolapse in a 71-year-old woman, with the cervix visible in the vaginal orifice.
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| Classification and external resources | |
| Specialty | Lua error in Module:Wikidata at line 446: attempt to index field 'wikibase' (a nil value). |
| ICD-10 | N81.4 |
| ICD-9-CM | 618.1 |
| DiseasesDB | 13651 |
| MedlinePlus | 001508 |
| Patient UK | Uterine prolapse |
| MeSH | D014596 |
Uterine prolapse is a form of female genital prolapse. It is also called pelvic organ prolapse or prolapse of the uterus (womb).
Risk factors for uterine prolapse include pregnancy, childbirth, chronic increases in intra-abdominal pressure such as lifting, coughing or straining, connective tissue conditions,[1][2] and damage to or weakness of the muscles.[3]
Treatment may be conservative or surgical and should be based upon patient symptoms and preference.
Pathophysiology and causes
The uterus (womb) is normally held in place by a hammock of muscles and ligaments. Prolapse happens when the ligaments supporting the uterus become so weak that the uterus cannot stay in place and slips down from its normal position. These ligaments are the round ligament, uterosacral ligaments, broad ligament and the ovarian ligament. The uterosacral ligaments are by far the most important ligaments in preventing uterine prolapse.
The most common cause of uterine prolapse is trauma during childbirth, in particular multiple or difficult births. About 50% of women who have had children develop some form of pelvic organ prolapse in their lifetime.[citation needed] It is more common as women get older, particularly in those who have gone through menopause. This condition is surgically correctable.
Treatment
Treatment is conservative, mechanical or surgical. Conservative options include behavioral modification and muscle strengthening exercises such as Kegel exercise.[4] Pessaries are a mechanical treatment as they elevate and support the uterus.[5][6] Surgical options are many[7] and may include a hysterectomy or a uterus-sparing technique such as laparoscopic hysteropexy,[8] sacrohysteropexy[9][10] or the Manchester operation.[11]
In the case of hysterectomy, the procedure can be accompanied by sacrocolpopexy.[12] This is a mesh-augmented procedure in which the apex of the vagina is attached to the sacrum by a piece of medical mesh material.[13]
Further reading
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References
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- ↑ Price N, Slack A, Jackson S. Laparoscopic hysteropexy: the initial results of a uterine suspension procedure for uterovaginal prolapse. BJOG 2010;117:62–68. doi:10.1111/j.1471-0528.2009.02396. www.bjog.org
- ↑ Lua error in package.lua at line 80: module 'strict' not found.
- ↑ Surgical correction of uterine prolapse: cervical amputation with uterosacral ligament plication versus vaginal hysterectomy with high uterosacral ligament plication By de Boer T, Milani F, Kluivers K, Withagen M, Vierhout M. Part of ICS 2009 Scientific Programme, Thursday 1 October 2009
- ↑ Lua error in package.lua at line 80: module 'strict' not found.
- ↑ NICE interventional procedure guidance IPG284: Sacrocolpopexy with hysterectomy using mesh for uterine prolapse repair by the National Institute for Health and Care Excellence, Issued: January 2009
External links
- Illustrated description of Manchester Operation at atlasofpelvicsurgery.com
- The Pelvic Clinic
