UTERINE (Womb) PROLAPSE

Uterine prolapse means that your uterus (womb) has moved from its normal position and down into your vagina. The uterus may be only slightly out of place, or it may move down so far that it can be felt or seen outside the vagina.

The uterus is the muscular organ at the top of the vagina. Babies grow in the uterus, and menstrual blood comes from the uterus.

Also, as a woman ages and with a natural loss of the hormone estrogen, her uterus can drop into the vaginal canal, causing
the condition known as a prolapsed uterus.

·         Muscle weakness or relaxation may allow your uterus to sag or come completely out of your body in various stages:

o    First degree: The cervixdrops into the vagina.

o    Second degree: The cervix drops to the level just inside the opening of the vagina.

o    Third degree: The cervix is outside the vagina.

o    Fourth degree: The entire uterus is outside the vagina. This condition is also called procidentia. This is caused by weakness in all of the supporting muscles.

Other conditions are usually associated with prolapsed uterus. They weaken the muscles that hold the uterus in place:

·         Cystocele: A herniation (or bulging) of the upper front vaginal wall where a part of the bladder bulges into the vagina. This may lead to urinary frequency, urgency, retention, and incontinence (loss of urine).

·         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 that is relieved when you lie 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.

WHAT IS THE CAUSE?

Ligaments, muscles, and connective tissue normally hold your uterus and other organs in their proper places in your lower belly. If these tissues get weak, your uterus or other organs may press into or drop down into the vagina.

Childbirth is the most common cause of uterine prolapse, especially if you had a large baby or a long or difficult labor. The muscles and skin of the birth canal (vagina) are stretched and sometimes torn during childbirth. The tissues heal over time but may not be as strong as they were before.

Older women may have this problem because the loss of female hormones after menopause weakens the vaginal walls.

Over time, the following may increase your risk of having a uterine prolapse:

·         Inherited weak ligaments and muscles

·         Chronic coughing

·         Chronic constipation

·         Frequent heavy lifting

·         Frequent straining to pass bowel movements

·         Obesity

·         Injury to the vagina

WHAT ARE THE SYMPTOMS?

If the prolapse is mild, you may not have any symptoms.

If the prolapse is moderate or severe, your symptoms may include:

·         Leaking of urine when you cough, sneeze, laugh, lift heavy objects, or have sex

·         Trouble with bowel movements (such as infrequent bowel movements or leaking of bowel movements)

·         Low back pain

·         A feeling of heaviness or discomfort in your lower belly

·         Feeling like you are sitting on a ball

·         Finding that standing a long time makes the pain and discomfort worse

·         Pain during sex

·         Trouble urinating

All of your symptoms may get worse just before you start a menstrual period.

With severe prolapse, the uterus may feel like a large lump in the vagina. It may even be visible from the outside.

HOW IS IT DIAGNOSED?

Your provider will ask about your symptoms and do a pelvic exam.

HOW IS IT TREATED?

The treatment depends on your symptoms. Without treatment your symptoms might keep getting worse. The uterus could come down outside the vagina, causing bleeding and infection.

Possible treatments include:

·         Lifestyle changes: Sometimes the symptoms can be treated with changes in diet, medicine to soften the stool so that you are not straining when you have a bowel movement, weight loss, or avoiding strenuous activities.

·         Kegel exercises: These are exercises you can do to strengthen the muscles in and around your vagina. When you do Kegels, you squeeze and relax your pelvic muscles as though you were trying to stop a flow of urine.

·         Pessary: A pessary is a silicone or plastic device prescribed by your healthcare provider. It’s inserted into the vagina to help support the uterus, bladder, and rectum. It can help if you leak urine when you cough, strain, or exercise.

·         Surgery: You may need surgery to repair weakened tissue and put the uterus back into its proper place. In some cases, removal of the uterus (hysterectomy) may be recommended.

HOW CAN I TAKE CARE OF MYSELF?

·         Follow your provider’s advice for treatment.

·         Try to keep a healthy weight. If you are overweight, lose weight.

·         Eat high-fiber foods to help you move your bowels without straining.

·         Drink plenty of fluids.

·         Strengthen your pelvic muscles by doing Kegel exercises. It is especially helpful to do these exercises before and after childbirth.

·         Don’t wear tight underwear or clothing that puts pressure on your belly.

·         Avoid frequent heavy lifting. When you do lift, bend your knees and hips and keep your back straight.

·         If you have a chronic cough, talk to your healthcare provider about treating the cough.

·         If you smoke, try to quit.

If you have problems with leaking of urine, try to empty your bladder regularly before you have the urge to go. This will lessen the chance that urine will leak. You may also want to wear a pad to asorb wetness when you are doing something that may cause leaking (like running).

If you are concerned about the effect of childbirth on your pelvic tissues, discuss this with your healthcare provider before your baby is born.