First Prolapse

First Prolapse




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First Prolapse
From Wikipedia, the free encyclopedia
Condition in which organs fall down or slip out of place
For the British musical group, see Prolapse (band) .
Further information: Mitral valve prolapse
This section needs additional citations for verification . Please help improve this article by adding citations to reliable sources . Unsourced material may be challenged and removed. Find sources: "Prolapse" – news · newspapers · books · scholar · JSTOR ( June 2021 ) ( Learn how and when to remove this template message )

^ Page 41 in: Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series) . Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 978-0-7817-7153-5 .

^ Price N., Slack A., Jackson S. "Laparoscopic hysteropexy: the initial results of a uterine suspension procedure for uterovaginal prolapse." BJOG 2010;117:62–68. doi : 10.1111/j.1471-0528.2009.02396 . www.bjog.org

^
"Vaginal rejuvenation: sounds great. What is it?" . Beautycallbooks.com. Archived from the original on 2010-04-03 . Retrieved 2009-12-14 .

^ American Urogynecologic Society (May 5, 2015), "Five Things Physicians and Patients Should Question" , Choosing Wisely : an initiative of the ABIM Foundation , American Urogynecologic Society , retrieved June 1, 2015 , which cites:
Culligan, PJ (April 2012). "Nonsurgical management of pelvic organ prolapse". Obstetrics and Gynecology . 119 (4): 852–60. doi : 10.1097/aog.0b013e31824c0806 . PMID 22433350 . S2CID 21218937 .
ACOG Committee on Practice, Bulletins--Gynecology (September 2007). "ACOG Practice Bulletin No. 85: Pelvic organ prolapse". Obstetrics and Gynecology . 110 (3): 717–29. doi : 10.1097/01.aog.0000263925.97887.72 . PMID 17766624 . .

^ "Male reproductive behaviour of Naja oxiana (Eichwald, 1831) in captivity, with a case of unilateral hemipenile prolapse" . Herpetology Notes . 2018 – via https://www.biotaxa.org/hn/article/view/34541 . {{ cite journal }} : External link in |via= ( help )

^ "Calving Time Management for Beef Cows and Heifers - Oklahoma State University" . extension.okstate.edu . 1 January 2018 . Retrieved 11 May 2022 .

^ "Vaginal and Cervical Prolapse in Cattle and Sheep - Reproductive System" . MSD Veterinary Manual . Retrieved 11 May 2022 .

^ The Merck Veterinary Manual, 3rd ed.‚ Merck and co. Inc. Rahway, N.J., USA, 1967

^ V.L. Tharp, in Cattcott E.J. & Smithcors J.F. Equine Medicine and Surgery, American Veterinary Publications Inc., 2nd ed 1972, French translation Vigot Frères, Paris, France, 1974, ISBN 2-7114-0653-9 . OCLC 461509749 .


In medicine , prolapse is a condition in which organs fall down or slip out of place. It is used for organs protruding through the vagina , rectum , or for the misalignment of the valves of the heart . A spinal disc herniation is also sometimes called "disc prolapse". Prolapse means "to fall out of place", from the Latin prolabi meaning "to fall out".

Relating to the uterus, prolapse condition results in an inferior extension of the organ into the vagina, caused by weakened pelvic muscles.

The main type of prolapse of heart valves in humans is mitral valve prolapse (MVP), which is a valvular heart disease characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole.

Tricuspid valve prolapse can cause tricuspid regurgitation . [1]

Rectal prolapse is a condition in which part of the wall or the entire wall of the rectum falls out of place. Rectal prolapse can be a medical emergency. In some cases, the rectum may protrude.

Symptoms of a rectal prolapse may be:

A surgeon may operate through the abdomen to secure part of the large intestine or rectum to the inside of the abdominal cavity ( rectopexy ). Sometimes the surgeon removes the affected part of the intestine.

Surgery also can be done through the perineum (the area between the genitals and the anus) to remove the prolapsing tissue.

Surgery is most often successful for people who still have some control over their bowel movements. If the anal sphincter is damaged, surgery may correct the prolapse but not be able to completely correct fecal incontinence (lack of control of bowel movements). Fecal incontinence can both potentially improve or deteriorate after prolapse surgery.

If the lining has fallen out of the anus and is around 7 cm or less, it should eventually retract back inside naturally, though the retraction can take up to four days.

Uterine prolapse (or Pelvic organ prolapse) occurs when the female pelvic organs fall from their normal position, into or through the vagina. Occurring in women of all ages, it is more common as women age, particularly in those who have delivered large babies or had exceedingly long pushing phases of labor. Smoking, obesity, connective tissue disorders, upper respiratory disorders‚ and repetitive strain injuries can all increase prolapse risk. Minor prolapse can be treated with exercises to strengthen the pelvic floor muscles (pelvic physiotherapy); more serious prolapse, e.g., complete procidentia , requires pessary use or reconstructive surgical treatment. Reconstructive pelvic prolapse surgery may be done without resorting to complete hysterectomy by hysteropexy, [2] the resuspension of the prolapsed uterus. Traditional gynecologic practice favors removal of the uterus or ovaries (or both) at the time of prolapse surgery, and one estimate states that of the 600,000 hysterectomies performed in the United States every year, 13 percent are for prolapse. [3] However, there is concern that many of these hysterectomies may be unnecessary and that hysteropexy would suffice as a treatment instead.

The rectum or urinary bladder may prolapse as a result of changes in the integrity of connective tissue in the posterior or anterior vaginal walls, respectively, resulting in pelvic floor prolapse . Symptoms may include a feeling of pressure in the pelvis, or the visible protrusion of organs from the vagina. Prolapse is almost never painful, but the change in position of organs may cause urinary or bowel symptoms.

Pessaries are a treatment option for pelvic organ prolapse. [4]

Umbilical cord prolapse occurs when the umbilical cord comes out of the uterus with or before the presenting part of the fetus. It is a relatively rare condition and occurs in fewer than 1% of pregnancies. Cord prolapse is more common in women who have had rupture of their amniotic sac. Other risk factors include maternal or fetal factors that prevent the fetus from occupying a normal position in the maternal pelvis, such as abnormal fetal lie, too much amniotic fluid, or a premature or small fetus. The concern with cord prolapse is that pressure on the cord from the fetus will cause cord compression that compromises blood flow to the fetus. Whenever there is a sudden decrease in fetal heart rate or abnormal fetal heart tracing, umbilical cord prolapse should be considered. Due to the possibility for fetal death and other complications, umbilical cord prolapse is considered an obstetric emergency during pregnancy or labor. Current management guidelines focus on quick delivery, which usually entails a cesarean section. With appropriate management, the majority of cases have good neonatal outcomes.

Genital prolapse has been reported in snakes and turtles. [5]

Oviduct prolapse is an often fatal condition in birds. When an egg is laid, the vagina everts through the cloaca to deliver the egg. Large eggs and avian obesity are contributors to this condition. Immediate veterinary assistance is paramount to the survival of a bird with prolapse. Even with immediate medical intervention the chances for survival are usually uncertain. Untreated birds will begin to tear at the injury site, and other flockmates will begin to cannibalize the prolapse area, a behaviour commonly known as pickout.

Prolapsed uterus in cattle, particularly dairy cattle, generally occurs in the first 12 hours post-calving. [6] Frequent causes are hypocalcemia combined with irritation of the birth canal, causing straining. Replacement of the protrusion, which can range from the size of a softball to the hanging of the entire uterus down below the hocks, is performed with the cow in sternal recumbency, an epidural injection, and hindlimbs 'frogged' rearwards to allow the pelvis to tip forward, easing replacement. [ citation needed ] Careful washing and cleaning prior to replacement is important as is ensuring that the horns are completely everted once inside the cow. Often a Buhner suture is placed in the vulva to prevent subsequent reprolapse. Another type of reproductive prolapse in cattle is so-called bovine vaginal prolapse .

Rectal prolapse is a condition routinely identified in pigs on farms and at slaughterhouses. If not reduced quickly, prolapses in pigs become necrotic and infected, and risk being cannibalized by other pen mates. If the latter happens it normally results in death of the animal by sepsis , shock or faecal peritonitis .

Rectal prolapse occurring in horse and mule would be better termed anal prolapse , as it only involves mucous membrane moving posteriorly to form a circular protrusion outside the anus [8] The condition is not painful.

In mares after parturition , it is described as a 10 to 60 mm mucous protrusion. [9]

In young mules and foals, anal prolapse occurs with a frequency similar to that of Gasterophilus haemorrhoidalis . In extensive breeding conditions, the disease is only recognized after some days, leading to intense edema of prolapsed tissues and necrosis of the mucous membrane.

Early cases in should be treated with the application of hygroscopic substances like powdered sugar followed by purse-string suturing . When prolapsed tissues are edematous and necrotic, amputation is performed. The prognosis is fair as the removed tissues do not contain any important organs or large blood vessels.

Simple removal of prolapsed edematous tissues


Medically Reviewed by Traci C. Johnson, MD on September 24, 2022
Your uterus (or womb) is normally held in place inside your pelvis with various muscles, tissue, and ligaments. Because of pregnancy , childbirth or difficult labor and delivery , in some women these muscles weaken. Also, as a woman ages and with a natural loss of the hormone estrogen , their uterus can drop into the vaginal canal, causing the condition known as a prolapsed uterus.
Symptoms of a prolapsed uterus include:
Seek medical care immediately if you have any of the following:
Notify your doctor if you have any of the following symptoms:
Uterine prolapse happens when vaginal childbirth or other conditions weaken the muscles and tissues of the pelvic floor so they can no longer support the weight of the uterus. It can happen as a result of:
Your health care provider can diagnose uterine prolapse with a medical history and physical examination of the pelvis.
Treatment depends on how weak the supporting structures around your uterus have become.
You can strengthen your pelvic muscles by performing Kegel exercises. You do these by tightening your pelvic muscles, as if trying to stop the flow of urine. This exercise strengthens the pelvic diaphragm and provides some support. Have your health care provider instruct you on the proper ways to isolate and exercise the muscles.
Estrogen (a hormone) cream or suppository ovules or rings inserted into the vagina help in restoring the strength and vitality of tissues in the vagina. But estrogen is only for use in select postmenopausal women.
Depending on your age and whether you wish to become pregnant, surgery can repair the uterus or remove it. When indicated, and in severe cases, your uterus can be removed with a hysterectomy . During the surgery, the surgeon can also correct the sagging of the vaginal walls, urethra, bladder, or rectum. The surgery may be performed by an open abdominal procedure, through the vagina, or through small incisions in the abdomen or vagina with specialized instruments.
If you do not want surgery or are a poor candidate for surgery, you may decide to wear a supportive device, called a pessary, in your vaginal canal to support the falling uterus. You can use this temporarily or permanently. They come in various shapes and sizes and must be fitted to you. If your prolapse is severe, a pessary may not work. Also, pessaries can be irritating inside your vagina and may cause a foul-smelling discharge.
If you are not a good candidate for a hysterectomy or a pessary and are not going to have intercourse again, there is an option for a surgery called colpocleisis. During this procedure, the walls of the vagina are sewn shut.
Follow-up depends on how your condition was treated.
Pessaries can be effective temporarily or permanently if they are checked and cleaned as often as necessary. Surgery can support a prolapsed uterus or remove it.
Sarah Samreen, MBBS, Instructor, Department of Health Sciences, Ziauddin Medical University, Pakistan.
George Lazarou, MD, FACOG, Director, Urogynecology and Reconstructive Pelvic Surgery.
Jack D. Weiler, MD, Montefiore Medical Center and assistant professor, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine.
Aneela Naureen Hussain, MD, MBBS, assistant professor, Department of Family Practice, State University of New York Downstate Medical Center.
Suhaib Waqarul Haq, MBBS, Medical Officer, Department of Radiology, Abbasi Shaheed Hospital, Karachi, Pakistan.
Jeter (Jay) Pritchard Taylor III, MD, vice-chief/compliance officer Department of Emergency Medicine, Palmetto Richland Memorial Hospital, University of South Carolina.
Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine.
Lee P. Shulman, MD, professor of Obstetrics and Gynecology, head, Section of Reproductive Genetics, Feinberg School of Medicine, Northwestern University, Chicago.
Cleveland Clinic: “Cystocele (Fallen Bladder).”
John Hopkins Medicine: “Uterine prolapse.”
StatHealth : “Pelvic Prolapse Imaging.”
© 2005 - 2022 WebMD LLC. All rights reserved.
WebMD does not provide medical advice, diagnosis or treatment.

Pelvic Organ Prolapse: Easy Help for the first 2 stages
Most women who’ve given birth know about basic pelvic floor health and the wonders Kegels can do, but pelvic organ prolapse (POP) may not be as familiar a term. Even though up to 40% of women develop some form of prolapse, many do not discuss prolapse with their clinicians until symptoms are well developed.
POP develops when weakened pelvic floor muscles allow the pelvic organs (i.e., uterus, bladder, and rectum) to protrude into or below the vagina. Your pelvic floor muscles are actually a layered network that creates a “hammock” or sling-like support for your bladder, rectum, and uterus. When the supporting structure stretches or weakens, the organs begin to drop and press into the vaginal wall. There are three basic types of POP:
Symptoms. One of the problems with prolapse is that women may not notice the problem until the condition has significantly progressed. Some symptoms to look out for include:
Stages. Clinicians divide POP into four stages, depending on how far the organ has descended into or beyond the vagina.
Any condition that puts excessive pressure on the pelvic floor or compromises the muscle strength in your pelvic floor can contribute to developing POP. The largest risk of POP is women who’ve given birth, particularly vaginal deliveries. Other risk factors include:
After a pelvic exam, your doctor may suggest a variety of treatment depending on the severity of your prolapse. The main goal of any pelvic organ prolapse treatment is to create a stronger foundation for your pelvic organs. The type of prolapse and its cause will determine which treatment is right for you.
Conservative treatment involves strengthening the pelvic floor muscles by doing Kegel exercises . About 1 in 3 women do Kegels incorrectly, but there are external devices, like ELITONE , that do your Kegels for you. This is effective for the first 2 mild stages.
This vaginal device is an alternative to surgery. Pessaries are made of silicone or latex and range in shape from a ring (similar to a diaphragm) for mild prolapse to a cube for more severe cases. When inserted up into the vagina, a pessary helps support the protruding bladder, rectum, or uterus. Pessaries are fitted to the individual and require periodic removal and cleaning, either at home (mild prolapse) or in a doctor’s office (severe prolapse).
As a last resort, women undergo surgery to remedy the prolapse. The type of surgery depends on the diagnosis and can be done vaginally, laparoscopically, or abdominally.
Women can take steps toward preventing POP by minimizing some of the risk factors (e.g., lose weight, stop smoking) and improving their pelvic floor health. One of the most important aspects of pelvic floor health is toning and strengthening your pelvic floor muscles. Kegel exercises play a big part in reinforcing these muscles, but they can be tricky to do effectively. Externally applied devices, like ELITONE , can do your Kegels for you, resulting in stronger pelvic floor muscles and fewer bladder leaks. In addition, because ELITONE is externally applied (unlike vaginal devices), it is comfortable, worn under clothing as you continue other tasks, convenient, and easy to use. Learn more about ELITONE .
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Vaginal prolapse is a condition where your vagina slips out of position. It happens when the tissues and muscles in your pelvis weaken and overstretch. It’s more common in people who have had multiple vaginal deliveries during childbirth and have gone through menopause.


The American College of Obstetricians and Gynecologists. Pelvic Support Problems. (https://www.acog.org/womens-health/faqs/pelvic-support-problems) Accessed 9/15/2022.
InformedHealth.org [Internet]. Pelvic organ prolapse: Overview. (https://www.ncbi.nlm.nih.gov/books/NBK525783/) 2018 Aug 23. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Accessed 9/15/2022.
Kuncharapu I, Majeroni B, Johnson D. Pelvic Organ Prolapse. (https://www.aafp.org/afp/2010/0501/p1111.html) American Family Physician . May 2010; 81(9): 1111-1117. Accessed 9/15/2022.
Merck Manual Professional Version. Uterine and Apical Prolapse. (https://www.merckmanuals.com/professional/gynecology-and-obstetrics/pelvic-organ-prolapse-pop/uterine-and-apical-prolapse) Accessed 9/15/2022.
The Women’s, The Royal Women’s Hospital Victoria Australia. Vaginal Prolapse. (https://www.thewomens.org.au/health-information/vaginal-prolapse) Accessed 9/15/2022.
Women’s Health Concern. Prolapse: Uterine and vaginal. (https://www.womens-health-concern.org/help-and-advice/factsheets/prolapse-uterine-vaginal/) Accessed 9/15/2022.


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