Uterine prolapse: Management, Complications, Nursing management&Intervention

 Uterine Prolapse 

Uterine prolapse is an abnormal position of the uterus in which the uterus protrudes downward. 

Pathophysiology and Etiology 

• Uterus herniates through pelvic floor and protrudes into vagina (prolapse ) and possibly beyond the introitus (procidentia). 
• Usually caused by obstetric trauma and overstretching of musculofascial supports 
• Degree 
• First degree- cervix prolapses into vaginal canal.
• Second degree- cervix is at the introitus.
• Third degree - cervix extends over the perineum.
• Marked procidentia - the entire uterus protrudes outside vaginal cavity.
• The pelvic organ prolapse quantified system may be used to evaluate prolapse

Clinical Manifestations 

• Backache or abnormal pain.
• Pressure and heaviness in vaginal region. 
• Bloody discharge because of cervix rubbing against clothing or inner thighs. 
• Ulceration of cervix. 
• Symptoms are aggravated by obesity, standing, straining, coughing, or lifting a heavy object because of increased intra-abdominal pressure.

Diagnostic Evaluation 

Pelvic examination identifies conditions 

Management 

• Hysterectomy or surgical correction 
• Vaginal pessary  - plastic device inserted into vagina as temporary or palliative measure if surgery cannot be done.
• Estrogen cream - to decrease genital atrophy 

Complications 

• Necrosis of cervix, uterus.
• Infection. 

Nursing Assessment 

• Obtain history of childbirth and surgery. 
• Ask about symptoms and aggravating factors.
• Examine patient in lying or standing position; if cervix not readily visible, spread labia gently, do not attempt to insert speculum.

Nursing Diagnosis 

• Acute pain related to downward pressure and exposed tissue. 
• Impaired tissue integrity related to exposed cervix and uterus. 
• Sexual dysfunction related to loss of vaginal cavity.

Nursing Intervention 

Relieving pain

• Administer sitz bath and explain procedure to patient. 
• Provide heating pad for lower back or lower abdomen. 
• Administer pain medications as ordered. 
• Check for proper placement of pessary. 
• Increase fluid intake and encourage patient to void frequently to prevent bladder infection. 

Maintaining cervical and uterine mucosal integrity 

• For second, and third-degree prolapse, apply saline compresses frequently. 
• Provide postoperative care
• Administer perineal care to patient after each voiding and defecation.
• If urinary retention occurs, catheterize or use indwelling catheter until bladder tone is regained
• Apply an ice pack locally to relive congestion

• Promote ambulation but prevent straining to reduce pelvic pressure. 

Restoring sexual function 

• Discuss with patient noncoital sexual activity before treatment is instituted.
• Explain to patient that sexual intercourse is possible with pessary; however, vaginal canal may be shortened. 
• Reinforce surgeon's instructions postoperatively about waiting to have vaginal penetration.
• Encourage patient to explore with partner ways to engage in sexual activity without strain with greatest comfort.