REPROSAIT 4 U

Prolapse of the uterus

The uterus (womb) is an organ of the female reproductive system.

It is shaped like an upside down pear and is located inside the pelvis.

The uterus, bladder and bowel are supported by a tight hammock of muscles slung between the tailbone (coccyx) and the pubic bone. These muscles are known as the PELVIC FLOOR, or the LEVATOR ANI MUSCLES.

Ligaments and connective tissue also anchor the uterus in place. If these tissues are weakened or damaged, the uterus can slip down into the vagina.

Common causes of uterine prolapse include CHILDBIRTH – OBESITY – CHRONIC CONSTIPATION and POSTMENOPAUSE .

Other names for uterine prolapse include PUDENDAL HERNIA and PELVIC FLOOR HERNIA

Treatment options include special muscle strengthening exercises. Surgery may be needed in severe cases.

Symptoms

The symptoms of uterine prolapse include:

1. A sensation of heaviness in the vagina
2. A distinct lump or bulge in the vagina
3. Tissue protruding out of the vagina
4. Persistent aching in the lower back
5. Trouble passing urine
6. Frequent urinary tract infections
7. Greater than normal amounts of vaginal discharge
8. Painful sexual intercourse.

Degrees of prolapse

Uterine prolapse is categorised by the degree of tissue protruding into the vagina. In most cases, other pelvic organs (such as the bladder or bowel) are also prolapsed into the vagina, and the ovaries sit lower than normal inside the pelvis. The three categories of uterine prolapse are:

• FIRST DEGREE (mild) - the neck of the uterus (cervix) protrudes into the lowest third 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.

A range of causes

The pelvic floor and associated supporting ligaments can be weakened or damaged in many ways including:

1. Pregnancy, especially in the case of multiple babies such as twins or triplets.
2. Vaginal childbirth, especially if the baby was large or delivered quickly, or if there was a prolonged pushing phase.
3. Obesity.
4. Chronic constipation and associated straining to pass motions.
5. Low levels of the sex hormone oestrogen after menopause.
6. Constant coughing associated with conditions such as chronic bronchitis or asthma.
7. Fibroids.
8. In rare cases, pelvic tumour.

Pelvic floor exercises

In mild to moderate cases, special exercises of the pelvic floor can correct uterine prolapse. Familiarising yourself with the muscles of each orifice gives you a better chance of performing the exercises correctly. To identify the muscles of your vagina, insert one or two fingers and squeeze them. For your urethra, halt the flow of urine in midstream, but do not do this on a regular basis. Finally, familiarise yourself with the muscles of your anus by pretending to stop yourself from breaking wind. Consult with your doctor, physiotherapist or health care professional to ensure correct performance. Basically, the pelvic floor exercises include:

• As a warm-up, direct your attention to your pelvic floor. Gradually squeeze all three sphincters and increase the tension until you have contracted the muscles as hard as you can. Release slowly and gently.
• Squeeze slowly and hold for five to 10 seconds. Release slowly. Repeat 10 times. Relax for 10 seconds in between each one.
• Perform quick, short strong squeezes. Repeat 10 times.
• Remember to squeeze your muscles whenever you sneeze or cough.

VAGINAL PESSARY
A device shaped like a doughnut may be inserted into the vagina and positioned to prop the cervix and uterus. Side effects include irritating discharge and an increased risk of ulceration. Vaginal pessaries are considered a short term solution, and pelvic floor exercises and perhaps surgery will still be needed in the longer term.

VAGINAL 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. The operation may be performed abdominally in some circumstances. In around nine out of 10 cases, corrective surgery is successful.

Prevention techniques

Some women are at increased risk of uterine prolapse. Simple preventive measures include:

• PREGNANCY - pelvic floor exercises throughout the duration of pregnancy.
• VAGINALCHILDBIRTH - a well-timed episiotomy (an intentional and controlled cut of the skin between the vagina and anus) to prevent tearing and trauma to the pelvic floor muscles caused by the baby’s emerging head, and post-partum pelvic floor exercises.
• POSTMENOPAUSE - oestrogen creams to boost flagging hormone levels, and pelvic floor exercises.
• OBESITY - loss of excess body fat with dietary modifications and regular exercise, and pelvic floor exercises.
• OTHER CONDITION - treat underlying disorders (such as asthma, chronic bronchitis or chronic constipation) in consultation with your doctor.
• CHRONIC CONSTIPATION - drink plenty of fluid, eat lots of fruit, vegetables and fibre, and relax your tummy muscles to avoid straining when using your bowels.

Point to remember

• Uterine prolapse occurs when weakened or damaged muscles and ligaments allow the uterus to slip into the vagina.
• Common causes include pregnancy, childbirth, hormonal changes after menopause, obesity and chronic constipation.
• Treatment options include pelvic floor exercises and vaginal surgery.