Uterine prolapse is when the uterus (womb) slips down into the vagina. In severe cases, the organ can protrude from the vagina.
Description and Symptoms
Even if a sufferer doesn’t notice the uterus dropping, other symptoms may be evident, such as discomfort during sexual intercourse, an ache in the lower back, leaking urine (stress incontinence), abnormal vaginal bleeding, and an increased vaginal discharge.
In addition to a uterine prolapse, a prolapse of the bowel or bladder can occur, in which these organs start to bulge into the vaginal walls.
Causes
The uterus (womb) is held in place by a network of ligaments and muscles. These supports can weaken, leading to the uterus dropping.
The usual causes of the weakening of the supporting ligaments and muscles are:
- Childbirth (via vaginal delivery) is the primary cause. Uterine prolapse is common in women who have had many children or difficulty giving birth.
- Obesity is a significant risk factor. One study suggested that obese women had a 69% greater incidence of uterine prolapse compared to those with a healthy body mass index.
- Aging is another risk factor. The reduced level of hormones after the menopause tends to weaken the support for the uterus.
- A chronic cough or chronic constipation can make the condition more likely. Smokers are more likely to have a uterine prolapse since they often get a persistent cough.
- Repeated heavy lifting can also make the condition more likely.
Muscles, ligaments and other structures support the uterus in the pelvis. If these tissues get weak or stretched, the uterus falls into the birth canal. This process is what people call prolapse.
This condition affects a lot of women who have had 1 or more vaginal births.
Other factors that can cause or lead to uterine prolapse include:
- Lack of estrogen after menopause
- Conditions that put pressure on the pelvic muscles, such as a chronic cough and obesity
- Pelvic tumor (uncommon)
- Repeated effort to defecate due to prolonged constipation may make the problem worse.
Tests and exams.
Your health care provider will do a pelvic exam. You will be asked to push as if you are trying to eject a baby. This shows how much the uterus has gone down.
Uterine prolapse is mild when the cervix goes down to the lower part of the vagina. It is moderate when the cervix falls out of the vaginal opening.
Other situations that the pelvic exam can show are:
- The bladder and the anterior vaginal wall are protruding into the cystocele.
- The rectum and the posterior wall of the rectocele are protruding into the vagina.
- The urethra and bladder are lower in the pelvis than usual.
Treatments for uterine prolapse
It is vital that uterine prolapse gets treated. If left alone it may get worse, ultimately leading to a risk of ulcers and infections.
Lifestyle Changes: Sufferers should lose weight, give up smoking, and avoid any heavy lifting (including shopping, lifting children, etc.).
Pelvic Floor Exercises (Kegel Exercises) strengthen the pelvic floor muscles. One efficient way to prevent uterine prolapse is doing these exercises on a regular basis. Keeping such routine can even stop a mild prolapse from getting worse.
Vaginal Pessaries: Various sizes and shapes of vaginal pessary can be fitted to support the uterus.
These are typically made of plastic or rubber. The vaginal pessaries have to get removed at regular intervals for cleaning, but women can learn how to do this themselves.
Most women find that they can still have sexual intercourse when a pessary is in place, although some designs don’t permit this.
Side-effects include irritation of the vagina, which can lead to an increased vaginal discharge.
If a particular type of pessary is uncomfortable or causes side-effects, it’s worthwhile trying a different kind.
Surgery: Various surgical options are available to increase the support of the uterus. A standard operation, called Sacrohysteropexy, involves sticking a plastic mesh inside the body to support the uterus.
The procedure can be carried out using keyhole surgery, which gives a shorter recovery time than open abdominal surgery.
The operation usually works well and avoids the need for a hysterectomy. However, a minority of women suffer from continual pain or damage to the bowel or bladder.
A hysterectomy is sometimes used to cure uterine prolapse, particularly in women who have reached the menopause.
However, studies have shown that a hysterectomy in women under the age of 65 (who don’t have cancer) lowers overall life expectancy.
People should always consider alternative treatments should before a hysterectomy goes ahead.
Treatment is not necessary unless the symptoms cause too much pain or discomfort.
Many women receive treatment the moment the uterus goes down to the opening of the vagina.
CHANGES IN LIFESTYLE
The following may help control your symptoms:
- Lose weight if you are obese.
- Avoid straining and lifting heavy objects.
- Receive treatment for a chronic cough. If coughing is due to smoking, try quitting.
VAGINAL WEAKNESS
The care provider may recommend a threaded rubber or plastic device placed inside the vagina. This is called pessary. This device holds the uterus in place.
Women can use the pessary in the short or long term. The device fits your vagina. Some pessaries are similar to a diaphragm used for birth control.
Pessaries should get cleaned regularly. Sometimes it is necessary for the care provider to clean them. Many women can be taught how to insert, clean and remove the pessary.
Pessary side effects include:
- Smelly discharge from the vagina
- Irritation of the lining of the vagina
- Ulcers in the vagina
- Problems with normal sexual intercourse
SURGERY
Doctors should not operate the patient until the symptoms of prolapse are worse than the risks of having surgery. The specific type of surgery depends on:
- The severity of prolapse
- Women’s plans for future pregnancies
- Age, health and other health problems for women
- Women’s desire to preserve vaginal function.
Medical experts can perform some surgical procedures without removing the uterus, such as sacro-microspin fixation.
This procedure involves the use of the nearby ligaments to support the uterus. Other treatments are also available.
Vaginal hysterectomy is often used to correct uterine prolapse. Any lifting of the vaginal walls, urethra, bladder or rectum can also be corrected surgically at the same time.
