PROLAPSTJS 'UTERI (Lat., falling of the womb). The condition in which the womb falls below its natural position in the pelvic cavity and approaches the outlet of the vagina. If the womb appears outside it is known as pro cidentia, or complete prolapse. Thus we have all degrees of prolapse from a very slight depression to a complete extrusion, and in its descent not only does the womb itself fall down, but it drags with it the vaginal walls, usually a part of the bladder, and less frequently the rectum. The prolapsed portion of the bladder is known as a eystoeele, that of the rectum as rcctoccle. Pro lapse of the uterus is a very common affection, occurring most freqnently in women past middle age who have borne many children: but it is also found in unmarried women, and rarely in children. The causes are: (1) Relaxation of the ligaments that normally hold the uterus in place; (2) weakening of the support below due to a loss of tone in the tissues or to injury or lacera tion during labor: (3) an increase in weight in the uterus, either from congestion o• disease; and finally (4) an increased pressure within the abdo men forcing the uterus down, as in straining from constipation. The symptoms of this affec tion arise partly from the pressure of the womb on other organs, partly from the simultaneous displacement of adjacent parts (as the bladder, rectum, etc.), and partly from reflex action.
Patients with only a slight displacement usually complain of a sensation of fullness in the pelvis, of weight and bearing down, of dragging pain in the back, these symptoms being aggravated when the upright position is assumed. The treatment varies with the degree of displace ment. ln cases of complete prolapse the uterus should be replaced and retained in position if possible by mechanical means, such as tampons of cotton o• pessaries o• rings. In extreme cases removal of the entire organ may be necessary to afford relief. In cases of moderate severity great improvement is further secured by inereasing the general tone of the tissues by tonics and constitutional treatment and by and other forms of local applications. The improve ment in the general health is of great importance. In many instances an operation is necessary for the repair of the lacerated tissues at the pelvic outlet. Where neglected the condition has a tendency to become aggravated and rectal and bladder symptoms make themselves evident.