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What is Prolapse? Definition | Cause | Classification | Clinical Features | Diagnosis | Treatment

Definition :

Herniation or protrusion of a pelvic organ into or out of vaginal canal call the prolapse.

 Cause :
  • Atonicity or asthenia following menopause is most an important factor of prolapse. 
  • During menopause most of the women's pelvic muscle and the ligament that support genital tract become slack and atony because of deficiency of oestrogen. 
  • Major or minor degree prolapse can occur soon after childbirth which can be improved by pelvic floor muscle exercised. A birth injury like obtaining or tear cause anonymity. 
  • Delivery at home by untrained dai who ask a female to bear down before full dilatation of the cervix. 
  • The prolonged second stage of labour which stretching of uterosacral ligament. 
  • Ventous extraction of a foetus before full dilatation of cervix without any application of forceps. 
  • False method of a downward vigorous push to the uterus to expel placenta.
  • Laceration of the perianal body during childbirth unless sutured.
  • In nulliparous or unmarried can be because of spina bifida or split pelvis which results in the weakness of supporting muscles.
  • Family or hereditary history of pelvic prolapse. 
  • Delivery of big baby.
  • Rapid suction of pregnancy. 
  • Increase abdominal pressure like chronic bronchitis, chronic constipation. 
  • Abdominal perineal exertion. 
Prolapse


Classification of prolapse :

Prolapse :

1. Vaginal :

In vaginal anterior wall and posterior wall. 

In anterior wall urethrocele and cystocele. 

In posterior wall rectocele and enterocele. 

2. Utero-vaginal : 

In the uterovaginal first degree, second degree, third degree, fourth degree. 

First degree means descend of the cervix in the vagina. 

A second degree means the descent of cervix up to vaginal introitus. 

The third degree means the descent of cervix without vaginal introitus. 

Fourth degree called precedential it means the whole of uterus come out of vaginal introitus. 

Clinical Feature :
  • Patient complains something is descending in vaginal or protruding out at vulva. 
  • Prolapse aggravation by coughing, straining, heavy work amelioration by lying down. 
  • If large prolapse or external swelling may cause discomfort while walking or carrying regular duties. 
  • At the end of the day mid sacral blockage. 
  • Sometimes vaginal discharge. 
  • Decubitus or friction ulcer may present on procedentia which may be discharged by bleeding. 
  • Micturation difficulties like imperfect control or stress incontinence.
  • Coital difficulties which third degree and fourth degree prolapse. 
Lab diagnosis :

1. Physical examination :
  • The patient is asked to cough and straining to diagnosis nature and degree of prolapse. 
  • Vulval examination for perineal laceration. 
  • Vaginal orifice examination for relaxed opening. 
  • Perineal body and levator muscle are palpated to detect tone and dimension.  
  • Pervaginal examination to detect vaginal prolapse and degree of descent, condition of vagina and cervix. 
  • Vaginal examination: To know the length of the cervix position and mobility of uterus. 
  • The general condition of a patient is evaluated decided to fitness for surgery. 
2. lab investigation :
  • CBC 
  • Blood 
  • Urea 
  • Blood sugar 
  • Urine routine 
  • X-ray of chest and ECG 
Differential diagnosis :
  • Anterior vaginal wall cyst. 
  • Congenital elongation of the cervix. 
  • Cervical fibroid. 
  • Valvular cyst. 
  • A patient may mistake at rectal prolapse. 
Treatment :

1. Prophylaxis :
  • Careful attention during childbirth. 
  • Antenatal and postnatal physiotherapy. 
  • Proper supervision and management during the second stage of labour. 
  • Adequate rest after delivery. 
  • The span between pregnancy should be more. 
  • Avoid multiparity. 
  • It occurring in menopausal women prophylactic treatment HRT should be given. 
2. Medical treatment :
  • Pessary treatment: This is made up of soft plastic polyvinyl chloride ( PVC ) material available in a different size is palliative but not curative.  
3. Operative treatment :

Depend on the age of patient and degree of prolapse. The desire for children to retain uterus and general condition of the patient. 
  • Anterior colporrhaphy. 
  • Posterior colporrhaphy. 
  • Vaginal hysterectomy. 
  • Abdominal celling operation. 
  • Anterior colporrhaphy with amputation of elongation of cervix.
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