Womb On the Move: Uterine Prolapse

Prolapse is a common problem for females of all ages, worldwide. Yet prolapse is one of those conditions that many women are way too embarrassed to talk about, even with their closest friends.

Some can’t even discuss prolapse with their doctor, choosing instead to put up with light bladder leakage, discomfort, a poor sex life and low self esteem rather than get help, advice and treatment.

Uterine prolapse is the one of the most common types of prolapse. It’s sometimes called women’s number one health secret, because it’s one of those conditions that many have but few admit to. Yet it’s been around for a very long time, with uterine prolapse and its treatment first described by physicians in an ancient Egyptian text dated about 2000 BC.

Up until recently, hysterectomy (surgical removal of the uterus) was often the prescribed ‘cure’, which is maybe why so many women keep quiet about it! Nowadays, hysterectomy is a last resort, and usually only for severe cases of uterine prolapse.

Laparoscopic surgery to repair the damage (without removing anything) may be done if the prolapse is serious. But usually other, non-surgical solutions are the first line of treatment. While in mild cases where the symptoms aren’t a problem, no treatment is required at all.

What is a uterine prolapse?

A uterine prolapse is when your uterus gives in to gravity and heads south into your vagina. This happens because the pelvic floor muscles – a tight hammock of muscles slung between the tailbone (coccyx) and the pubic bone – and ligaments that support the uterus have weakened or stretched and so can no longer firmly hold the uterus in its rightful place.

Uterine prolapse often affects postmenopausal women who’ve had at least one vaginal delivery of a baby. Damage to supportive tissues during pregnancy and childbirth, loss of oestrogen, and repeated straining and lifting of heavy objects over the years all can weaken your pelvic floor and lead to uterine prolapse.

The symptoms of uterine collapse

  • The uterus and cervix protrude through the vaginal opening 

  •  Low backache

  • Frequent urination or a sudden, urgent need to empty the bladder (stress incontinence)

  • Sensation of heaviness or pulling in the pelvis

  • Difficult or painful sexual intercourse

  • Repeated bladder infections

  • Vaginal bleeding or an increase in vaginal discharge

  • You feel like you’re sitting on a small ball. But you’re not 

  • Many of the symptoms are worse when standing or sitting for long periods of time


Causes of uterine prolapse

Pregnancy and childbirth are the main causes of prolapse. The prolapse can happen immediately after pregnancy or up to 30 years later. Contributing factors include a large baby, a long and intense labor, and assisted labour.

Even though female bodies are good at recovering from pregnancy and birth, damaged muscles and ligaments sometimes never fully regain their strength and elasticity.

Large fibroids or pelvic tumors put women at an increased risk of prolapse.

Ageing and menopause further weaken the pelvic muscles, as the natural reduction of oestrogen at menopause causes muscles to lose some of their strength and elasticity.

Obesity puts you at increased risk of prolapse as the extra weight stresses internal support structures.

Chronic coughing from smoking or asthma can lead to prolapse due to the constant straining of muscles and ligaments.


Constipation and the associated straining to have a bowel movement can stretch ligaments and weaken your pelvic floor.


Heavy lifting can damage pelvic muscles. Women in careers that involve regular manual labor or lifting, such as farming, landscaping and nursing, have an increased risk of prolapse. 


Certain genetic conditions such as collagen deficiency increase the risk of prolapse even if there are no other risk factors.


Previous pelvic surgery, for example bladder repair procedures, may damage nerves and tissues in the pelvic region.


Spinal cord injury and other muscular atrophy conditions such as muscular dystrophy and multiple sclerosis increase the risk because pelvic muscles are paralysed or movement is restricted.

 

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Diagnosing uterine prolapse

If you suspect your uterus has slipped, it’s a good idea to see your doctor for diagnosis and to discuss what you should do about it. Uterine prolapse is one of those conditions that can get progressively worse, yet if caught in the early stages there is much that can be done to rectify the problem.

Diagnosis is quite simple. Your doctor will probably do a pelvic examination, asking you to bear down as if trying to push out a baby. This will show how far your uterus comes down.

Degrees of prolapse

First degree (mild) – the neck of the uterus (cervix) protrudes into the lowest third of the vagina but doesn’t protrude outside the opening of the vagina


Second degree (moderate) – the cervix protrudes to the opening of the vagina


Third degree (severe) – the whole uterus protrudes out of the vagina

Treatments for uterine prolapse

If you have mild uterine prolapse, treatment usually isn’t needed. But if the prolapse is painful, uncomfortable, or disrupting your normal activities such as your social life, sports activities or sex life, then check out some of the very effective treatment options and talk them over with your doctor or GP.

Pelvic floor exercises

In mild to moderate cases, pelvic floor exercises can correct uterine prolapse. These exercises are great for women of all ages and should be done daily to keep your nether regions in tiptop condition.

Vaginal pessary

This is a rubber or plastic device that comes in various shapes and sizes. Some are similar to a diaphragm. Others look like a small doughnut. It’s inserted into the vagina and positioned to prop up the cervix and uterus. You won’t be able to feel it once it’s in place.

There can be side effects such as an irritating discharge, but usually a pessary is a great way to correct uterine prolapse. Some pessaries may interfere with sex by limiting the depth of penetration, so if this is an issue for you, make sure you talk it over with your doctor and ask for a pessary that won’t spoil the fun.

Repair surgery

In moderate to severe cases, the prolapse may have to be surgically repaired. In laparoscopic surgery, slender instruments are inserted through the navel. The uterus is pulled back into its proper place and reattached to supporting ligaments using permanent stitches. Over time, scar tissue grows over these stitches and further strengthens the repair. In around nine out of 10 cases, corrective surgery is successful.

Lifestyle changes

Regardless of how mild or how bad the prolapse, there are several things you can do to help improve the condition:

  • Lose weight if you’re carrying too many kilos

  • Get someone else to do the heavy lifting 

  • Quit smoking and stop the coughing that can make symptoms worse 

  • Eat a high-fibre diet, drink lots of water and regularly exercise to avoid constipation and boost your general health and wellbeing


Prevent uterine prolapse

Women are prone to uterine prolapse, so don’t keep the information to yourself – share it with your friends and daughters, especially those who are planning to start a family or are approaching menopause.

Pregnancy – pelvic floor exercises before and after pregnancy


Post menopause – oestrogen creams to boost flagging hormone levels, and pelvic floor exercises


Obesity – loss of excess body fat with dietary modifications and regular exercise, plus pelvic floor exercises


Other conditions – treat underlying disorders (such as asthma, chronic bronchitis or chronic constipation) in consultation with your doctor


Chronic constipation – as well as eating a high-fibre diet and drinking lots of water, remember to relax your tummy muscles to avoid straining when having a bowel movement


Managing light bladder leakage

Light bladder leakage and/or stress incontinence usually going hand in hand with uterine prolapse.

So, while you wait for your treatment or for your pelvic floor exercise regimen to take effect, use discreet Poise products for discreet protection.

 

 

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Prolapse Surgery

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