Uterine Prolapse in Emergency Medicine Clinical Presentation

Updated: Dec 29, 2015
  • Author: Raafat S Barsoom, MD; Chief Editor: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE  more...
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Presentation

History

Mild cases of uterine prolapse may have no obvious symptoms. If symptoms are present, they are less bothersome in the morning but worsen as the day goes on.

Patient may complain of one or more of the following:

  • A feeling of heaviness or pressure in the pelvis
  • Feeling as if sitting on a small ball or as if something is falling out of the vagina
  • Pain in the pelvis, abdomen, or lower back
  • Pain during intercourse
  • A protrusion of tissue from the vagina
  • Recurrent urinary tract infections (UTIs)
  • Unusual or excessive discharge from the vagina
  • Difficulty with urination, including involuntary loss of urine ( incontinence), or urinary frequency or urgency
  • Symptoms may be worsened by prolonged standing or walking; (this is due to the added pressure placed on the pelvic muscles by gravity.
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Physical Examination

An abdominal examination should be performed to exclude the presence of an abdominal or pelvic tumor that may be responsible for the prolapse. Pelvic examination to assess the degree of prolapse is usually performed with the woman either in the left lateral position using a Sims speculum or in a semirecumbent position in the examination chair. Physical findings may be enhanced by having the patient strain during the examination or by having her stand or walk prior to examination. In addition, digital examination in a standing position allows an accurate assessment of the degree of the prolapse.

Stages

See the list below:

  • Stage I - Descent of the uterus to any point in the vagina above the level of the hymen
  • Stage II - Descent to the level of the hymen
  • Stage III - Descent beyond the hymen
  • Stage IV - Total eversion or procidentia
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