🔑 Key Learning

  • Caused by weakness of the pelvic floor muscles and connective tissue.
  • Presents with a dragging sensation or a visible/palpable vaginal mass.
  • Symptoms may include urinary, bowel, and sexual dysfunction.
  • Managed conservatively with pelvic floor exercises or pessary, or surgically if severe.

🧬 Pathophysiology

  • Loss of pelvic floor integrity leads to descent of the uterus and vaginal walls.
  • Risk factors include:
    • Vaginal delivery
    • Advancing age and menopause
    • Chronic raised intra-abdominal pressure (e.g. obesity, cough, constipation, heavy lifting)
    • Connective tissue disorders

👀 Clinical Features

  • Pelvic heaviness or dragging sensation
  • Sensation of a vaginal bulge or “something coming down”
  • Visible/palpable cervix or uterus at the vaginal introitus
  • Urinary symptoms:
    • Stress incontinence
    • Urgency, frequency
    • Incomplete bladder emptying
  • Bowel symptoms:
    • Constipation, straining, incomplete evacuation
  • Sexual dysfunction:
    • Dyspareunia
    • Reduced sensation
Figure 204: Uterine prolapse - cervix visible in the vaginal orifice

     

💊 Management

Pelvic Floor Muscle Training

  • Pelvic floor exercises (Kegel exercises)
  • Specialist physiotherapy for pelvic floor rehabilitation

Pessary Devices

  • Vaginal ring pessary used to support prolapsed organs
  • Regular monitoring and pessary changes required

Surgical Management

  • Vaginal wall repair (colporrhaphy)
  • Uterine suspension procedures:
    • Sacrospinous fixation
    • Uterosacral ligament suspension
    • Sacrohysteropexy (mesh or native tissue)
  • Hysterectomy (vaginal or abdominal) if childbearing is complete or prolapse is severe

📝 Exam Clues & Clinchers

  • Elderly postmenopausal woman with vaginal bulge, urinary frequency and incomplete voiding.
  • “Something coming down” sensation and visible cervix at the introitus.