Uterine prolapse & Fistulas Raja Nursing Instructor RN, DCHN, Post RN. BSc.N 31/03/2016
Objectives 1. Review the anatomy & physiology of female reproductive system 2. Discuss the causes, pathophysiology, manifestation, medical and surgical management of following female reproductive disorders, Uterine prolapse Fistulas
External Parts of the Female Reproductive System Labia Majora Labia minora Bartholin s gland These glands are situated at the sides of the opening of the vagina. They also secrete mucus for lubrication during sexual intercourse. Clitoris It is a tiny yet sensitive protrusion, similar to the male penis. The clitoris can become erect and very sensitive to stimulation just like the male penis.
Internal Parts of the Female Reproductive Organ Vagina Uterus Ovaries Fallopian tubes
Vagina Functions: Passageway for sperm-uterus Drainage menstrual fluids Passageway for infant s birth
Uterus Parts: Cervix Corpus (body) Fundus (upper part) Layers: o Perimetrium o Myometrium o Endometrium
Uterus Cervix ( Lower part) Internal orifice or ostium (os) External os Functions: Lubricates vagina and acts as bacteriostatic agent Provides alkaline environment to protected deposited sperm from acidic ph of the vagina Produces mucous plug in the cervical canal during pregnancy
Fallopian Tubes (2) Functions Passageway for sperm to meet ovum Site of fertilization Safe nourishing environment for fertilized ovum (zygote) Transport zygote to corpus of uterus Ovaries (2) Functions: Production of estrogen and progesterone Maturation of ovum during each reproduction cycle
Functions of the female reproductive system It is responsible for the production of oocytes or ova, which are necessary for sexual reproduction. It is also serves as the site where the transportation of ova passes through going to the place of fertilization. Fertilization or conception usually happens in the fallopian tubes. Implantation follows when the fertilized egg implants into the uterus walls. This marks as the first stage of pregnancy. In case fertilization or implantation does not occur, the reproductive system is responsible for menstruation. The system is also responsible for producing female sex hormones needed to maintain the cycle of reproduction.
Uterine Prolapse Uterine prolapse is falling or sliding of the womb (uterus) from its normal position into the vaginal area. Pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus. The uterus then slips down into or protrudes out of the vagina. Mostly affects postmenopausal women who've had one or more vaginal deliveries.
Conti Weakening of the pelvic muscles that leads to uterine prolapse can be caused by: Damage to supportive tissues during pregnancy and childbirth Effects of gravity Loss of estrogen Repeated straining over the years
Symptoms Feeling like sitting on a small ball Difficult or painful sexual intercourse Frequent urination or a sudden urge to empty the bladder Low backache Uterus and cervix that stick out through the vaginal opening Repeated bladder infections Feeling of heaviness or pulling in the pelvis Vaginal bleeding Increased vaginal discharge
Degree of Prolapse First degree Cervix remains within the vagina Second degree Cervix protrudes through the introitus Third degree or procidentia Uterus lies entirely outside the introitus
Management Vaginal Pessary Minor displacement Surgical Hysterectomy
Fistulas Fistula is an abnormal connection between organ or structure. A rectovaginal fistula is an abnormal connection between the lower portion of large intestine rectum and vagina. Contents of bowel can leak through the fistula, meaning might pass gas or stool through vagina.
Rectovaginal fistula may result of: Injury during childbirth is the most common cause Crohn's disease is second most common cause Cancer or radiation treatment of pelvic area. Surgery involving vagina, perineum, rectum or anus Other causes rarely: Infections, Diverticulitis, Ulcerative colitis
Symptoms Depending on the size and location of the fistula. Passage of gas, stool or pus from vagina foul-smelling vaginal discharge Recurrent vaginal or urinary tract infections Irritation or pain in the vulva, vagina and the area between vagina and anus (perineum) Pain during sexual intercourse Management Medical Antibiotics Surgical To close or repair the abnormal connection