Chapter 122 Uterine Prolapse
INTRODUCTION
Description: Uterine prolapse is loss of the normal support mechanism resulting in descent of the uterus down the vaginal canal. In the extreme, this may result in the uterus descending beyond the vulva to a position outside the body (procidentia).
ETIOLOGY AND PATHOGENESIS
Causes: Loss of normal structural support as a result of trauma (childbirth), surgery, chronic intra-abdominal pressure elevation (such as obesity, chronic cough, or heavy lifting), or intrinsic weakness. Most common sites of injury are the cardinal and uterosacral ligaments and the levator ani muscles that form the pelvic floor, which may relax or rupture. Rarely, increased intra-abdominal pressure from a pelvic mass or ascites may weaken pelvic support and result in prolapse. Injury to or neuropathy of the S1 to S4 nerve roots may also result in decreased muscle tone and pelvic relaxation.
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