Uterine prolapse is defined as the extrusion of the uterus through the pelvic floor or vaginal introitus. Prolapse is caused by weakened pelvic floor muscles and is common in older, multigravid women. In first-degree prolapse, the cervix descends into the lower third of the vagina, while in second-degree prolapse, the cervix usually protrudes through the introitus. Third-degree prolapse, or procidentia, is characterized by externalization of the entire uterus with eversion of the vagina. Symptoms include a sensation of inguinal traction, low back pain, urinary incontinence, and the presence of a vaginal mass.
Management and Disposition
Refer patients with first- or second-degree prolapse to a gynecologist for pessary placement or surgical correction. Urgent gynecologic consultation is indicated for procidentia. Temporize with manual reduction of the uterus into the vaginal vault and place the patient on complete bed rest.
With procidentia, the exposed uterus is prone to abrasion and secondary infection.
Valsalva maneuver may reproduce or increase prolapse, cystocele, and enterocele.
Uterine prolapse may be confused with a cystocele (discussed below), enterocele, or soft-tissue tumor.
Third-Degree Uterine Prolapse. Note the protrusion of the entire uterus with the cervix visible through the vaginal introitus. (Photo contributor: Lawrence B. Stack, MD.)