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Monday, 13 June 2011

Uterine Prolapse

A few days ago, I performed a vaginal hysterectomy on a patient with uterine prolapse. She had a 3rd degree uterine prolapse with the entire uterus hanging out of the vagina!. It is actually quite unusual to see these cases nowadays with women having only a couple of children. In the olden days when women tended to have large families this was very much more common, and when I was working in the UK, a vaginal hysterectomy for prolapse was one of the most common operations performed. These women would come with the complaint of pressure below, a lump appearing or tell the doctor that she was turning into a man!.

Prolapse is a gradual process and results from damage to the supporting tissues at childbirth. As a woman ages especially in her 40s and 50s, there is increased laxity of the collagen due to decreasing female hormones, oestrogen. The prolapse then worsens. 1st degree and 2nd degree prolapse are less severe, but 3rd degree prolapse or procidentia can result in damage to the kidneys due to kinking of the ureters between the kidneys and the bladder, ulcers and cancerous change of the cervix due to the constant rubbing on underwear. My patient did indeed have swollen kidneys before surgery but an xray after the hysterectomy showed that the kidneys had reverted back to normal size. A 3rd degree prolapse and hysterectomy can be prevented if prolapse is detected in the earlier stages and supportive surgery performed. A sensation of heaviness, constipation, difficulty with urination or leakage of urine on excercise or coughing may indicate uterine prolapse.



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