Retroverted Uterus - An Overview

Introduction

Usually, in women, the uterus is located upright, either vertically or in an up-and-down position. However, in some women, the uterus is positioned pointing toward the lower back. This condition is known as the retroverted uterus. A retroverted uterus is a common condition affecting approximately one in five women. Generally, it is considered to be a normal anatomical variation and rarely causes health complications.

What Is Retroverted Uterus?

A uterus that is tilted backward, curving towards the spine instead of tipping forward towards the abdomen, is retroverted. It is also known as a tilted uterus, retroflexed uterus, or tipped uterus. While some women are born with a retroverted uterus, others may develop it later in life. Even though women with a retroverted uterus may experience painful menstruation and discomfort during sex, they do not face serious health problems.

What Are the Causes of a Retroverted Uterus?

The causes of a retroverted uterus are as follows:

• Natural Variations: As women mature, the uterus tilts forward naturally. In some women, this change does not occur, and the uterus remains tipped backward.

• Endometriosis: Endometriosis is a condition in which cells similar to the lining of the uterus grow outside the uterus. These cells help the uterus attach itself to other pelvic structures, which pulls the uterus into a retroverted position.

• Fibroids: These noncancerous lumps on the uterus can change its position and make the uterus susceptible to tipping backward.

• Adhesions or Scarring: A band of scar tissue that unites two separate anatomical surfaces together is adhesion. Pelvic surgeries, infections, or pelvic inflammatory disease (PID) can cause scar tissue in the uterus to attach to other organs resulting in a retroverted position of the uterus.

• Pregnancy: The uterus is held in its position with the help of bands of connective tissue known as ligaments. In some women, pelvic floor muscles and ligaments that become overstretched and weakened after giving birth causes the uterus to tip backward, resulting in a retroverted uterus.

• Genetics: Some women are born with a retroverted uterus.

What Are the Symptoms of a Retroverted Uterus?

Some women with a retroverted uterus do not experience any symptoms. However, the symptoms commonly seen are as follows:

• Pain in the lower back region or vagina during sexual intercourse.

• Pain during menstruation.

• Urinary tract infections (UTIs).

• Trouble inserting tampons during menstruation.

• Protrusion of lower abdomen.

• Urinary incontinence (feeling of pressure in the bladder or increased urine frequency).

How to Diagnose a Retroverted Uterus?

The following methods are used to diagnose a retroverted uterus:

• Pelvic Examination: A routine pelvic examination by the doctor can help in diagnosing a retroverted uterus. During this examination, the doctor feels the location of the uterus and cervix, which helps in determining the tilt of the uterus.

• Pap Test: In some women, the presence of a retroverted uterus is found during Pap test. A Pap test is a procedure in which cells from the surface of the cervix and nearby areas are removed using a small brush to be tested under a microscope for cervical cancer. This test also helps in detecting conditions like infections or inflammation.

• Ultrasound: Ultrasound is an imaging test that produces pictures of the organs and structures within the body using sound waves. Ultrasound can help in diagnosing a retroverted uterus by ruling out other possible conditions like endometriosis or uterine fibroids. In some women, a retroverted uterus is diagnosed only when they are pregnant from the ultrasound scan taken during pregnancy.

What Are the Treatment Options for a Retroverted Uterus?

Usually, asymptomatic women who have a retroverted uterus do not require any treatment. In women who face problems due to a retroverted uterus, the treatment options recommended are as follows:

• Treating the Underlying Condition: If the retroverted uterus is due to an underlying condition like endometriosis treating the underlying condition would help in improving the symptoms.

• Pessary: It is a small silicone or plastic device that is inserted into the vagina to support the uterus, vaginal walls, and other pelvic structures to bring a forward tilt and reposition the uterus to an anteverted position. But pessaries have been associated with painful sexual intercourse and increased risk of inflammation and infections. The doctors consider this only a temporary solution since the uterus will revert to its original position once the device is removed.

• Exercises: If the movement of the uterus is not disturbed by conditions like fibroids or endometriosis, some doctors can manually reposition the uterus into a forward position during a pelvic examination. In such cases, certain exercises may help strengthen the tendons, ligaments, and pelvic muscles to hold the uterus in that position. Kegels exercises, which involve tightening and holding the pelvic muscles (like trying to hold back the urine) for a few seconds and then releasing, can be beneficial in some patients. Other exercises that might help are as follows:

1. Pelvic Contractions: These are done to strengthen the pelvic muscles. It involves lying on the back with the arms at the sides and inhaling while lifting the buttocks off the ground. Hold this position for some seconds and release it while exhaling. This should be repeated almost ten to 15 times.

2. Knee-To-Chest Stretches: This involves lying on the back with both knees bent and feet on the floor. One knee should be raised to the chest by slowly pulling it with both hands. This position should be held for 20 seconds and then released. The same should be repeated for the other leg.

• Surgery: Laparoscopic surgical techniques have been beneficial in repositioning the uterus to a forward-facing position. This uterine suspension surgery can be done with or without a mesh. In most women, this surgery permanently fixes the tilted uterus and provides pain relief. In severe cases, surgical removal of the uterus (hysterectomy) is advised.

Conclusion

Having a retroverted uterus rarely interferes with pregnancy or fertility. Since a retroverted uterus does not cause any serious health issues, it is not a worrisome condition. However, women who experience pain during intercourse or any other symptoms should consult a doctor to find out if a retroverted uterus is responsible for the discomfort and follow the right treatment plan to get relief from the symptoms.