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UTERINE PROLAPSE

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UTERINE PROLAPSE 

Uterine prolapse occurs when the uterus slips or sags from its normal position and protrude out of the vagina.

  • This happens when the pelvic muscles and ligament stretches and weaken such that they are no longer able to provide adequate support for the uterus.
  • It can occur in women of any age but it is prevalent in postmenopausal women who have had one or more vaginal deliveries.
  • Uterine prolapse can be classified into complete or incomplete
  • A complete uterine prolapse occurs when the uterus descends so down that some portion protrudes outside of the vagina.
  • An incomplete uterine prolapse occurs when the uterus is only partially displaced into the vagina but does not protrude.
  • The stages of the condition are determined by how far the uterus has descended
  • First stage/degree: the cervix descends downward into the vagina
  • Second degree: the cervix slips down to the opening of the vagina
  • Third degree: the cervix has protruded out of the vagina
  • Fourth stage: the entire uterus is outside the vagina

CAUSES

The following can cause weakened pelvic muscles and tissues:

  • Pregnancy
  • Delivery related factors such as trauma, having a vaginal delivery, or delivering a large baby
  • Frequent heavy lifting
  • A chronic cough
  • Straining during a bowel movement
  • Previous pelvic surgery
  • Reduced estrogen level especially after menopause
  • Obesity
  • Being underweight

SYMPTOMS

Mild uterine prolapse may not be accompanied with any symptoms

Moderate to severe uterine prolapse may have symptoms which include:

  • Vaginal bleeding
  • Tissue protruding out of the vagina
  • Increase in vaginal discharge
  • Lower back pain
  • Urinary leakage or retention
  • The feeling that one is sitting on a ball
  • Heaviness or pulling in the pelvis
  • Constipation or difficulty with bowel movement
  • Difficulties with sexual intercourse

DIAGNOSIS AND TREATMENT

 

DIAGNOSIS

To make a diagnosis, the doctor will evaluate the symptoms and carry out a pelvic exam.

While examining the pelvis, the doctor may ask you to bear down as if you are about to have a bowel movement, this helps the doctor in assessing how severe your condition is and how far the uterus has descended into the vagina

The doctor in testing the strength of your pelvic muscles may ask you to tighten it.

 

TREATMENT

Treatment option depends on the stage and the severity of the prolapse

Non-surgical treatment may include:

  • Performing Kegel exercises regularly. They are pelvic floor exercises that help with strengthening the vaginal muscles.
  • Avoid lifting weight
  • Losing weight
  • Treating constipation
  • Wearing a vagina pessary. This is a vagina device that fits under the cervix and helps support and stabilizes the uterus and cervix. It must be removed, cleaned and reinserted occasionally. Pessaries come in different shapes and sizes.

Severe uterine prolapse may need surgical intervention. Surgery can involve:

Removal of the uterus (hysterectomy). The surgery may be performed through an incision on the abdomen (abdominally), the vagina walls (vaginally) or by using a special instrument to perform the surgery through tiny incisions (laparoscopically)

Repairing the weakened pelvic floor tissue

Surgery is not advised for women who plan on having children