Procidentia

Procidentia
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Synonyms	Uterine prolapse
Pronounce	N/A
Specialty	N/A
Symptoms	Pelvic pressure, vaginal bulge, urinary incontinence
Complications	Ulceration, infection
Onset
Duration
Types	N/A
Causes	Weakening of pelvic support structures
Risks	Childbirth, aging, obesity
Diagnosis	Physical examination
Differential diagnosis	Cystocele, rectocele
Prevention	N/A
Treatment	Pessary, surgery
Medication	N/A
Prognosis	Good with treatment
Frequency
Deaths	N/A

Procidentia, also known as uterine prolapse, is a condition characterized by the descent of the uterus into or beyond the vaginal canal due to the weakening of the pelvic support structures. It is a severe form of pelvic organ prolapse and can significantly impact a woman's quality of life.

Etiology

Procidentia occurs when the muscles and ligaments that support the uterus become weakened or damaged. This can be due to several factors, including:

• Childbirth: Vaginal delivery, especially multiple or traumatic births, can stretch and weaken pelvic support tissues.
• Aging: As women age, the tissues naturally lose strength and elasticity.
• Obesity: Excess weight increases pressure on the pelvic floor.
• Chronic cough or constipation: These conditions can lead to increased abdominal pressure, further straining pelvic support structures.
• Hysterectomy: Removal of the uterus can sometimes lead to prolapse of other pelvic organs.

Clinical Presentation

Patients with procidentia may present with a variety of symptoms, including:

• A sensation of pelvic pressure or heaviness
• A visible bulge or protrusion from the vaginal opening
• Urinary symptoms such as incontinence or retention
• Bowel symptoms, including constipation or difficulty with bowel movements
• Sexual dysfunction

Diagnosis

Diagnosis of procidentia is primarily clinical, based on a thorough pelvic examination. The degree of prolapse is often graded using the Pelvic Organ Prolapse Quantification System (POP-Q), which provides a standardized method for assessing and documenting the extent of prolapse.

Management

Treatment options for procidentia depend on the severity of the condition and the patient's symptoms and preferences. They include:

• Conservative management:

 * Pessary: A device inserted into the vagina to support the uterus and hold it in place.
 * Pelvic floor exercises: Strengthening the pelvic muscles can help alleviate symptoms.

• Surgical management:

 * Vaginal hysterectomy: Removal of the uterus through the vaginal canal.
 * Uterine suspension procedures: Techniques to reposition and support the uterus without removal.

Prognosis

With appropriate treatment, the prognosis for women with procidentia is generally good. Surgical interventions have high success rates, and conservative measures can provide significant symptom relief.

Also see

• Pelvic organ prolapse
• Cystocele
• Rectocele
• Pessary
• Hysterectomy