Uterine Prolapse

 

Prolapse refers to a collapse, descent, or other change in the position of the uterus in relation to surrounding structures in the pelvis.

 

Uterine prolapse occurs when a woman’s uterus falls into her vagina due to the weakness of certain muscles. This weakness may allow the uterus to come completely out of the body cavity with inversion of the vagina. The prolapse of the uterus is usually associated with defects of the vaginal wall. When the vaginal wall becomes thin and other organs bulge through it, this condition is called a herniation.

 

Prolapse of the uterus may be one of three types, depending on severity:

 

·         First-degree prolapse occurs when the uterus (cervix) sags downward/droops into the upper vagina.

 

      ·         Second-degree prolapse occurs when the cervix is at or near the outside of the vagina (the introitus). 

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·         Third-degree prolapse (sometimes referred to as total prolapse) occurs when the entire uterus is outside the vagina, also called procidentia. This is caused by weakness in all of the supporting muscles. Chronic irritation and dryness causes a thickening of the outside layer of the cervical and vaginal tissue, which leads to lesions and bleeding.

 

 

·         Associated conditions

·         Cystocele: A herniation of the upper front vaginal wall where a part of bladder bulges into the vagina, which leads to urinary frequency, urgency, retention, and incontinence.

·         Enterocele: The herniation of the upper rear vaginal wall where a small bowel portion bulges into the vagina. Standing leads to a pulling sensation and backache and is relieved by lying down.

·         Rectocele: The herniation of the lower rear vaginal wall where the rectum bulges into the vagina. This makes bowel movements difficult to the point that you may need to push on the inside of your vagina to empty your bowel.

 

 

 

CAUSES:

 

The following conditions can cause a prolapsed uterus:

·         Frequent vaginal birth deliveries

·         Weakness in the pelvic muscles with advancing age

·         Postmenopausal weakening and loss of tissue integrity

·         Conditions leading to increased pressure in the abdomen such as chronic cough, constipation, pelvic tumors, or an accumulation of fluid in the abdomen

·         Radical surgery in the pelvic area leading to loss of external support

·         Risk factors

·         Bearing multiple children

·         Advancing age

·         Increased intra-abdominal pressure

·         Excess weight lifting  

                 More common among women during and after menopause

 

 

PREVENTION: -

 

·         Reduce your weight.

·         Avoid constipation by eating a high-fiber diet.

·         Consider hormonal replacement therapy if you have had menopause.

·         Do Kegel exercises to strengthen your pelvic muscles.

 

 

SIGNS & SYMPTOMS: -

 

·         Fullness or pressure in your pelvis

·         Low back pain

·         Feeling of something coming out of the vagina

·         Painful intercourse

·         Difficulty with urination or defecation

·         Difficulty walking

 

 

HOME CARE: -

 

·         Perform Kegel exercises.

·         Performed by tightening your pelvis muscles as if trying to stop the flow of urine.

·         This exercise strengthens the pelvic diaphragm and provides some support.

·         Avoid lifting weights.

 

 

NEED FOR MEDICAL INTERVENTION: -

 

Notify your doctor if you experience any of the following symptoms:

·         You feel the cervix near the opening of the vaginal canal or if you suffer persistent discomfort from urinary dribbling or rectal urgency.

·         You may not feel the cervix but just pressure in the vaginal canal and the feeling of something coming out of your vagina.

·         You have persistent low back pain with difficulty in walking, urination, and defecation.

 

 

EMERGENCY TREATMENT: -

 

Go to a hospital’s Emergency Department if you experience the following:

·         Obstruction or difficulty in urination and or defecation

·         Complete uterine prolapse occurs

 

 

 

TREATMENT OPTIONS: -

 

Treatment Options for Prolapsed Uterus depends on how weak supporting structures around the uterus have become.

·         Estrogen cream (estrogen is a hormone) inserted into the vagina helps in restoring the strength of tissues in vagina.

·         Kegel exercises are helpful in strengthening the pelvic floor muscle.

·         In severe cases where the condition is uncontrollable, surgery is done to repair or replace the supporting structures of the uterus.

·         Removal of the uterus (the operation is called a hysterectomy) is also an option.

·         Women who do not want surgery or who are a poor candidate for surgery wear a supportive device, called a pessary, in their vaginal canal to support the falling uterus.

 

There are several options for uterine prolapse. In general, treatment is necessary only if you are experiencing symptoms such as pain or pressure, urinary incontinence, urinary retention, pain with intercourse, or recurrent infections or ulcerations associated with extreme degrees of prolapse (to the point that the cervix is protruding outside the vagina). If you are not having any symptoms, there is no reason to do anything at all. If the pressure you experience at the end of the day doesn't bother you, then you do not need surgery of any sort.

 

 

A pessary -- a rubber or latex device that is placed into the vagina to elevate the uterus -- is one such option. Some pessaries look very much like a contraceptive diaphragm and are easy for the user to remove and replace herself. Others look like mushrooms or cubes and must be removed, cleaned and replaced periodically by the doctor; this latter type is not compatible with an active sex life.

 

Another option is a uterine suspension. This surgery may be done via a laparoscope and involves shortening the ligaments that support the uterus, thus elevating it. Success rates for this procedure are fair.

 

Hysterectomy, usually via a vaginal approach, is a final option. Obviously, a hysterectomy is reserved for women who no longer wish to have children.

 

Part of the informed consent process in medicine involves advising you of your options and the risks and benefits associated with each option, and then allowing you to make the choice that is best for you.

PROGNOSIS

With proper treatment, the prolapsed uterus has a good prognosis.

 

 

FOLLOW-UP

Follow-up depends on how your condition was treated.

·         If you have had surgery, you need to follow up according to your surgeon’s advice.

·         If you have a pessary inserted in your vagina, it needs to be cleaned and checked for the correct position and fit at regular intervals.

·         If you have been told to do Kegel exercises, you should have a regular follow-up visit so that the doctor can check the progress of your muscle strength.