Prolapsed Uterus

The Uterus

The female reproductive system consists of a number of organs and structures including the uterus, ovaries, fallopian tubes, cervix and vaginal canal. The primary function of the reproductive system is to support procreation by facilitating the development of the foetus during pregnancy and to then facilitate childbirth. The uterus or womb is where the foetus is located during its gestation.

This organ is situated in the pelvic cavity, between the urinary bladder and the rectum. It is a muscular and hollow organ sprouting one ovary on either side. The lower section of the uterus leads into the vagina by way of the cervix. Pelvic organs like the uterus and urinary bladder are held in place by the muscles of the pelvic floor. Think of the pelvic floor as a sort of hammock anchored at opposite ends by the tailbone and the pubic bone. The uterus is also supported by a group of ligaments. Together, these structures are responsible for keeping the uterus in its designated position.

What Is Uterine Prolapse?

Sometimes, the supportive structures of the uterus, i.e. the pelvic floor and the ligaments anchoring the organ, become stretched, damaged or otherwise weakened. They are no longer able to fully support the uterus. As a result, the uterus slips out of its normal position. On account of gravity, it tends to sink into the vagina. In extreme cases, it may even fall all the way out of the vaginal opening. This is known as prolapse of the uterus.

Depending on the extent of the condition, treatment approaches may vary. When uterine prolapse is mild, it may be possible to rectify it by regularly practicing exercises that strengthen the muscles of the pelvic floor. On the other hand, if the prolapse is severe, the patient may be advised to undergo surgery.

What Is Responsible For A Prolapsed Uterus?

Uterine prolapse may be caused by any condition that injures or weakens the pelvic floor or ligaments responsible for holding the uterus in its proper place. One of the better-known causes of uterine prolapse is childbirth. The more vaginal births that a woman has undergone, the greater is her risk of developing uterine prolapse later in life. This is so because vaginal birth places great stress on the pelvic floor, causing its muscles to stretch.

This partly explains why the condition is more common among postmenopausal women. Research has also indicated that it may have to do with dipping estrogen levels around the time of menopause.

The list below lays out some known risk factors for uterine prolapse:

• Obesity.
• Chronic constipation.
• A chronic cough as a result of health conditions like bronchitis.
• Having undergone pelvic surgery.
• Abnormal growths like tumors or fibroids.
• Pregnancy and childbirth (particularly vaginal birth). Women who have been through several pregnancies and those pregnant with twins, triplets or more fetuses at once are at a greater risk of developing uterine prolapse.
• Prolonged labor.
• Delivering a large baby.
• Hormonal changes, particularly around the time of menopause.

Strengthen your pelvic floor muscles with these effective Kegel exercise gears.

What Are The Signs Of A Prolapsed Uterus?

The answer to this question depends on the actual extent of prolapse. In the mildest of cases, the uterus sags a little into the top part of the vagina and the patient may experience an uncomfortable feeling as a result. In more extreme cases the uterus may actually bulge out of the vaginal opening where it would be clearly visible. The worst-case scenario involves the entire organ slipping completely out of the vagina and out of the body.

If you suspect that you may be suffering from a case of uterine prolapse, check this list to see if any of your symptoms match with it:

• Uncomfortable sensation of sitting on a soft mass.
• Feeling like something inside the pelvis is being pulled or weighed down.
• A fleshy mass actually protruding from the vaginal opening.
• Ache in the lower back area.
• Excessive vaginal discharge.
• Bleeding from the vagina.
• Difficulties with intercourse.
• Frequent infections of the urinary bladder.
• In extreme cases, the entire uterus may slip out of the vagina.

Are There Different Types Of Prolapse?

Not in the exact sense of the term. However, it is possible to speak of different degrees of uterine prolapse. Broadly, any case of uterine prolapse is either described as ‘complete’ prolapse or ‘incomplete’. However, there can be quite a few shades in between those extremes. In clinical practice, an individual case may be assigned one out of four possible grades in terms of severity.

Grade 1: The uterus sags into the upper end of the vaginal canal.

Grade 2: The uterus sinks further into the vaginal canal and nears the opening.

Grade 3: The cervix or a portion of the uterus is visibly or palpably bulging out of the vaginal opening.

Grade 4: The entire uterus has slipped out of the vagina.

 

Left untreated, a number of severe outcomes may develop

• If prolapse of the uterus is caused by weakening of the pelvic floor, then there is a chance that other pelvic organs such as the urinary bladder may also suffer a prolapse. The rectum may also prolapse.
• Alternatively, the pressure that the uterus puts on the vagina itself can cause the vaginal walls to develop ulceration.
• When the uterus protrudes from the vagina, there is a risk of it becoming infected and inflamed.
• Vaginal ulcers could become infected too.

How Is It Diagnosed and Treated?

The first stage of diagnosing a prolapsed uterus involves carrying out a physical examination of the patient. You will be asked to lie down so that the doctor can conduct a pelvic exam. Unless the uterus is visibly protruding from the vagina, the doctor will most probably use an instrument called a speculum to dilate the vaginal opening and view the cervix. At this point, the doctor will be able to assess the degree of prolapse.

He or she will then need to determine the cause. Stresses as a result of pregnancy, chronic constipation or long-term respiratory illness, combined with the effects of gravity and hormonal changes may together account for uterine prolapse in the majority of cases. For this reason, it is necessary to evaluate your medical history. Any other supporting symptoms relating to menopause would be relevant in making the diagnosis.

As for treatment, this depends on the extent of prolapse. If the prolapse is very minimal, you will be asked to regularly perform exercises to strengthen the pelvic floor and regain normal function of those supportive structures. If the patient is obese, she will be advised on how to lose weight as this will relieve the uterine prolapse as well. In other cases, the patient may require active medical intervention to prevent complications such as infections and to prevent the uterus from prolapsing further. This may involve the use of a removable device known as a vaginal pessary that helps by supporting the uterus when placed within the vagina. However, this does not serve as a long-term solution.

Surgery can help to correct the condition either by repairing the prolapse or by actually removing the uterus altogether. The latter procedure is known as a hysterectomy and it is recommended only in the most extreme cases.

Prevention

Any woman is at risk of developing uterine prolapse, particularly if she has undergone pregnancy and vaginal childbirth. However, this risk may be compounded by other factors such as obesity. Hence, the good news is that it is possible to limit the risk by remaining in shape, eating healthy and performing Kegels exercises to keep the muscles of the pelvic floor in robust condition. If you are nearing menopause, you may consult your gynecologist about the possibility of estrogen replacement therapy.

References