Introduction
Uterus prolapse describes a clinical picture in which the uterus sinks into the vagina. The reason for this is weakness of the supporting tissue in the pelvis and the pelvic floor muscles. The affected women feel a foreign body feeling in the vagina.
The bladder or rectum are often also affected due to direct neighbourhood relationships. The diagnosis of uterine prolapse can be made by a gynaecological examination. Firstly, a speculum is used to observe how the uterus behaves when coughing or pressing. On the other hand, a prolapse of the uterus and the surrounding pelvic floor muscles can also be palpated directly.
What does the gynecologist do?
If there is a suspicion of uterine prolapse, the gynaecologist first performs an examination with a speculum. With the speculum the vagina and the cervix can be seen better. This examination is also part of every normal cancer screening.
The vagina and cervix are first examined in a relaxed state and then during the patient’s pressing and coughing. The increase in pressure in the abdominal cavity, which is triggered by these maneuvers, can have a direct effect on the position of the uterus. This is followed by a palpation of the internal genitals.
During this examination, it is determined how far the reduction has already progressed. In addition, the strength of the pelvic floor muscles can be assessed, at least for orientation. The palpation examination also includes a digital rectal examination.
During this examination, the gynecologist inserts a finger into the anus. The examination serves to determine the tension (tone) of the external sphincter muscle. If this muscle can no longer contract sufficiently, fecal incontinence may be the result.
However, a reliable diagnosis of uterine prolapse is made with ultrasound (sonography). During this examination, the ultrasound probe is inserted into the vagina. In this way, the uterus and also the surrounding pelvic organs can be examined in detail.
If a uterine prolapse is detected, an ultrasound of the bladder must also be made during the course of the procedure with various measurements to ensure that there is no urine accumulation in the bladder and that the bladder can be emptied normally. The uterine prolapse can be determined by the gynaecologist with a palpation. The higher the degree of severity, the easier it is to palpate the prolapsed uterus.
During the palpation examination an attempt is made to palpate the cervix. The cervix is the lowest part of the uterus. This makes it possible to determine how far the prolapse of the uterus has progressed and what the degree of severity is.
During the palpation the patient is asked to push or cough. This increases the pressure in the abdominal cavity and can further increase the uterine prolapse and make it visible in the early stages. Even with a grade 1 uterus prolapse, the cervix reaches deep into the vagina and can therefore be palpated by the gynaecologist without any difficulty. In the case of advanced prolapses, the patient can also feel the cervix herself. If the uterus already protrudes above the level of the vaginal outlet, parts of the uterus further up the cervix can be palpated in addition to the cervix.
