Prolapse of the uterus is any descent of the uterus below its normal position in the pelvis. Most patients refer to this as “falling of the womb”.
A first degree uterine prolapse descends to the point where the cervix is at the vaginal opening. Casual inspection of the external genitalia will not detect this defect. When the cervix protrudes through the vaginal opening, a second degree prolapse is present, which can readily be seen by inspection. In a complete, or third degree, prolapse the entire uterus descends outside the vagina. This is rare.
The cause of a prolapse is due primarily to relaxation or tearing of the supporting pelvic structures of the uterus. The basic injury usually occurs during labor. However, weak or poorly developed pelvic structures may account for those cases developing in a nulliparous patient. Prolapse usually occurs a few years after menopause.
Cystocele, the protrusion of the urinary bladder through the vaginal wall, is often present because of the close proximity of the bladder to the vagina. The underlying factors causing weakness and relaxation of the supporting structures of the uterus will also involve the bladder. Similarly, rectocele, the hernial protrusion of part of the rectum into the vagina, is a frequent complication of prolapse because of laxity of pelvic floor structures. Surgical repair is the usual procedure.
