Prolapse of the uterus and cervix with eversion of the vagina typically occurs in older women and may be acute or chronic. Presentation may be with:
- a mass felt outside the vagina
- postmenopausal bleeding
- vaginal discharge
- urinary retention
- renal failure (secondary to kinking of the ureters).
The diagnosis is immediately obvious:
- If possible, the uterus should be replaced immediately.
- The bladder should be emptied as a full bladder or retention may impede replacing the uterus.
- The uterus may need to be wrapped with a warm saline swab prior to replacement.
- A ring pessary should be inserted once the uterus is replaced.
- The ring may not be retained if the introitus is wide, the perineum is deficient or the prolapse is very large. In these situations, the vagina may be packed with a vaginal pack covered in estrogen cream. This will improve tissue integrity prior to surgery.
- Following reduction of the prolapse, ensure that the patient is able to void- for some a catheter may be required.
- Time should be allowed for ulcer healing, reduction in oedema and treatment of infection before definitive surgery is carried out, as these may all affect healing post-operatively.