BMJ 2007;335:819-823 (20 October), doi:10.1136/bmj.39356.604074.BE
Clinical Review
Uterine prolapse
Anjum Doshani, research fellow1, Roderick E C Teo, subspecialty trainee in urogynaecology1, Christopher J Mayne, consultant urogynaecologist1, Douglas G Tincello, senior lecturer in urogynaecology2
1 Urogynaecology Department, Women's, Perinatal and Sexual Health Directorate, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW , 2 Reproductive Science Section, Cancer Studies and Molecular Medicine, University of Leicester, Robert Kilpatrick Clinical Sciences Unit, Leicester Royal Infirmary, Leicester LE2 7LX
Correspondence to: D G Tincello dgt4@le.ac.uk
| The first 150 words of the full text of this article appear below. |
Uterine prolapse is the herniation of the uterus into or beyond the vagina as a result of failure of the ligamentous and fascial supports. It often coexists with prolapse of the vaginal walls, involving the bladder or rectum. In the United Kingdom, the disorder accounts for 20% of women waiting for major gynaecological surgery.1
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Why should I read this article?
Most women with symptoms of prolapse will present to primary care, and initial assessment and treatment occurs here.2 An understanding of the pathophysiology, assessment, and management of prolapse is essential for the primary care team to streamline appropriate referrals to hospital. This article aims to cover these topics and to provide an overview of current management of secondary care.
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How common is uterine prolapse?
Why does prolapse occur?
Anatomy
Risk factors
Box 1 Risk factors for the development of prolapse2 4 7 9 10
Confirmed risk factors
Possible risk factors
What are the symptoms?
Box 2 Symptoms attributable to uterine prolapse
Vaginal symptoms
Urinary symptoms
Bowel symptoms
Sexual symptoms
Examining the patient
Box 3 The five stages of prolapse13 14
Management
Observation
Conservative treatment
Pelvic floor muscle training
Pessaries
Box 4 Key points for fitting pessaries and their subsequent management
Surgical treatment
Additional educational resources
Resources for health professionals
Resources for patients
What do we still need to know?
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- A Woman's Dilemma
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