Prolapse of Uterus – Clinical Signs, Diagnosis & Treatment

Uterine prolapse is descent of the uterus and cervix down the vaginal canal due to weakening of pelvic support structures (muscles, ligaments, and fascia). It may result in the uterus bulging into or beyond the vaginal introitus.

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Etiology (Causes)

• Multiparity (especially home delivery, large baby, instrumental delivery)

• Menopause (decreased estrogen → pelvic muscle weakness)

• Prolonged labor or difficult childbirth

• Chronic cough / constipation

• Obesity or heavy lifting

• Congenital weakness of pelvic supports

• Pelvic surgery complications

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Degrees of Uterine Prolapse

1. First Degree: Cervix descends into the vagina, but does not reach the introitus.

2. Second Degree: Cervix reaches the introitus.

3. Third Degree: Cervix protrudes outside the introitus.

4. Procidentia: Entire uterus is outside the vulva (complete prolapse).

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Symptoms of Uterine Prolapse

1. Feeling of something coming down per vaginam

2. Pelvic heaviness or dragging sensation

3. Lower backache

4. Dyspareunia (painful intercourse)

5. Urinary issues (frequency, retention, incontinence)

6. Constipation / rectal pressure

7. Visible mass protruding from vagina (in severe cases)

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Investigations

• Pelvic Examination (Sim’s speculum & bimanual exam)

• Per speculum and per vaginam exam

• Urinalysis (if urinary complaints present)

• USG pelvis (to assess uterus & exclude mass)

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Treatment & Management

1. Conservative Treatment

• Kegel’s Pelvic Floor Exercises

• Pessary Use (ring or cube-shaped support device in vagina)

• Weight reduction, avoid lifting heavy weights

2. Surgical Treatment

• Vaginal Hysterectomy with Repair (if woman has completed childbearing)

• Fothergill’s Repair / Manchester Operation – Preserves uterus (in young women)

• Uterosacral Ligament Suspension / Sacrocolpopexy (for vault prolapse after hysterectomy)

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Complications

• Ulceration or Decubitus ulcer of protruded cervix

• Cystocele / Rectocele / Enterocele

• Urinary retention or incontinence

• Recurrent UTI

• Infertility (in severe cases)

Homoeopathic Medicines for Uterine Prolapse

Medicine	Keynotes
Sepia	Bearing-down sensation, wants to cross legs, worse standing.
Lilium Tigrinum	Constant urge to support vulva with hand, sensation as if uterus would fall out.
Murex	Dragging pain, worse in the morning, frequent desire for sex.
Aloe soc.	Protruding piles with uterine symptoms; heaviness in pelvic organs.
Helonias	Weakness with prolapse, better when engaged in work.