prolapse
(prō'laps‵ 
)
[L. prolapsus, a falling forward]
A falling or dropping down of an organ or internal part, such as the uterus or rectum.
SEE: mitral valve prolapse; procidentia; ptosis.
hemorrhoidal p.The descent of hemorrhoidal tissues outside the anal verge.
iris p.Protrusion of the iris or part of the iris through an injury in the cornea.
ABBR: MVP
A relatively rare condition in which the cusp or cusps of the mitral valve billow into the left atrium during systole. The abnormality has many causes, but the most common and clinically significant cause is leaflet thickening and redundancy (myxomatous degeneration of the valve). Mitral valve prolapse affects about 3% of the U.S. population and is the primary cause of severe nonischemic mitral regurgitation. It is found equally in men and women, but men have a higher risk of cardiovascular (CV) complications; age over 50 increases that risk. Other risk factors for CV complications include mild to moderate mitral regurgitation, atrial fibrillation, and atrial enlargement. Physical examination and two-dimensional echocardiography diagnose the problem.In patients without evidence of mitral regurgitation, there are usually no symptoms, but in some patients, nonanginal chest pain, palpitations, dyspnea, and fatigue may be present. On auscultation, there may be a murmur at the apex that is present during all of systole (holosystolic). Sometimes only a midsystolic click and late systolic murmur are heard.
Simple prolapse requires no therapy, and most MVP patients have an excellent prognosis and live a normal life. However, if mitral regurgitation is present on physical examination or echocardiogram, antibiotic prophylaxis is indicated during surgical and dental procedures. If heart failure caused by severe mitral regurgitation develops, surgical repair of the valve is helpful.
ABBR: POP
Protrusion of the pelvic organs into or through the vaginal canal. This condition is usually due to direct or indirect damage to the vagina and its pelvic support system. The damage may be related to stretching or laceration of the vaginal wall, hypoestrogenic atrophy, or injury to the nerves of the pelvic support structures. SYN: vaginal hernia.Symptoms include noticing a mass within the vagina or protruding beyond the introitus; or sensations of pelvic pressure, groin pain, coital difficulty, sacral backache, bloody vaginal discharge, difficult bowel movements, and urinary frequency, urgency, or incontinence.
Preventive measures include treatment of chronic respiratory disorders or constipation, estrogen replacement for menopausal women, weight control, smoking cessation, avoidance of strenuous occupational or recreational stresses to the pelvic support system, and pelvic muscle exercise to strengthen the pelvic diaphragm.
Treatment may be nonsurgical (such as use of a vaginal pessary or pelvic floor muscle-strengthening exercises) or surgical, including reconstructive operations (sacrospinous ligament fixation or uterosacral ligament suspension), vaginal hysterectomy, and cystocele or rectocele repair.
p. of the rectum Protrusion of the rectal mucosa or full thickness of the rectum (procidentia). Internal or complete rectal prolapse can be identified radiographically or endoscopically without transanal protrusion.
p. of the umbilical cord Premature expulsion of a loop of umbilical cord into the cervical or vaginal canal during labor before engagement of the presenting part and a potentially life-threatening event that occurs in about 2 of 1000 births. The greatest danger of cord prolapse is neonatal asphyxia and death.
SEE: deceleration.
p. of the uterus Downward displacement of the uterus from its normal position in the female reproductive tract. It can be classified by its severity: 1st degree) the cervix is within the vagina; 2nd degree) the cervix protrudes through the introitus; 3rd degree) the uterus and inverted vaginal walls lie outside of the vaginal introitus. Uterine prolapse is usually caused by relaxation of the tissues that provide support for the pelvic organs.SYN: descensus uteri; hysteroptosia; procidentia.
This condition may be congenital or acquired; most often it is acquired. The etiological factors are congenital weakness of the uterine supports and injury to the pelvic floor or to the uterine supports during childbirth.
The condition is most often seen following instrumental deliveries or when the patient has been allowed to bear down during labor before the cervix is fully dilated. Frequently associated with this is a prolapse of the anterior and posterior vaginal walls, as seen in cystocele and rectocele. In the early stages there are dragging sensations in the lower abdomen, back pain while stand ing and on exertion, a sensation of weight and bearing down in the perineum, and frequency of urination and incontinence of urine in cases associated with cystocele. In the later stages, a protrusion or swelling at the vulva is noticed on stand ing or straining, and leukorrhea is present. In procidentia, there is frequently pain on walking, an inability to urinate unless the mass is reduced, and cystitis.
The treatment depends on the age of the patient, the degree of prolapse, and the associated pathology. Abdominal surgery with fixation of the uterus is required if the prolapse is complete.