Uterine Prolapse - Causes, Symptoms, and Treatment

Introduction:

The uterus is a part of the reproductive system, also known as the womb. It is located in the pelvis and shaped like a pear. The uterus holds the developing baby during pregnancy. It can stretch through the pregnancy to accommodate the baby and shrink back in size after delivery. Uterine prolapse occurs when the uterus slips or sags from its original position and into the vagina.

What Is Uterine Prolapse?

Uterine prolapse is a condition where the supporting structures of the uterus, like pelvic floor muscles and ligaments, become weak over time. As a result, the uterus drops down or protrudes out of the vagina. The severity of the prolapse can vary depending on the weakening of the uterus' supporting system. Usually, mild uterine prolapse does not require any treatment, but treatment is required in a severe prolapse where the uterus may have slipped into the vagina. This prolapse generally creates a bulge or lump outside of the vagina.

What Can Cause Uterine Prolapse?

The uterus is held in position by a group of pelvic muscles and ligaments. These muscles are known as the pelvic floor muscles. When these muscles and the ligaments weaken, they can not hold the uterus in position, which can lead to sagging of the uterus. This can occur due to a number of reasons:

• Pregnancy.

• Obesity.

• Difficult labor or trauma during the time of delivery.

• Giving birth to a large baby.

• Aging causes loss of muscle tone leading to pelvic muscle weakness.

• Chronic coughing or straining.

• Chronic constipation.

• Low level of estrogen after menopause.

• Continuous weight lifting.

• Major surgery in the pelvic area leads to loss of external support.

• Smoking.

What Are the Symptoms of Uterine Prolapse?

There will be no obvious symptoms in mild cases of uterine prolapse. But, in severe cases, as the uterus slips further out of position, it can cause pressure on other pelvic organs like the bowel or the bladder. The symptoms can worsen when women walk or stand for long periods because gravity puts extra pressure on the pelvic muscles. The symptoms of uterine prolapse are as follows:

• A feeling of pressure or heaviness in the pelvic region.

• Pain during intercourse.

• Pain in the abdomen, pelvis, and lower back.

• Uterine tissue slips through the opening of the vagina.

• Frequent bladder infections.

• Urination problems include urine frequency (the need to urinate frequently), urine incontinence (involuntary loss of urine), inability to empty the bladder completely, or urine urgency (sudden urge to urinate).

• Constipation.

• Excess or unusual vaginal discharge.

• The sensation of looseness in the tone of vaginal tissue during sex.

How Is Uterine Prolapse Diagnosed?

During diagnosis, a pelvic examination is carried out, in which a doctor asks to bear down as in having a bowel movement which helps the doctor assess the severity of uterus prolapse. They may also ask to tighten the pelvic muscles as if trying to stop a stream of urine. This will help to check the strength of the pelvic muscles.

• The doctor will also examine the patient while they lie down, stand, and cough or strain to check the increased pressure in their abdomen.

• In ureteral obstruction cases due to complete prolapse, renal sonography or intravenous pyelogram (IVP) will be performed.

• In severe incontinence cases, the doctor might recommend tests to measure bladder functions called urodynamic testing.

• An ultrasound scan will be performed to rule out other pelvic problems.

• Magnetic resonance imaging (MRI) is sometimes done if there is more than one prolapsed organ.

What Is the Treatment for Uterine Prolapse?

There are two options for treating uterine prolapse: nonsurgical and surgical. The doctors will provide treatment based on the severity of the prolapse, age, general health, and plan for childbirth. Treatment options can include the following:

1) Nonsurgical Treatments:

• Lifestyle Modifications - If the uterine prolapse causes mild or no symptoms, simple lifestyle modifications may help prevent the worsening of the prolapse and prevent complications. Lifestyle modifications include performing Kegel exercises to strengthen the pelvic muscles, treating constipation, and losing weight.

• Vaginal Pessary - A vaginal pessary is a rubber or plastic ring inserted into the vagina to support the sagging tissues. A doctor will fit a pessary, and it must be removed frequently for cleaning.

2) Surgical Treatment:

• Hysterectomy - Uterine prolapse can be treated by surgically removing the uterus; this procedure is called a hysterectomy. This surgery is done through an abdominal incision (abdominal hysterectomy) or the vagina (vaginal hysterectomy). This is major surgery, and it is often a safe surgery, but removing the uterus means pregnancy is not possible after that. So the woman becomes infertile.

• Prolapse Repair Without Hysterectomy - This surgical procedure involves placing the uterus back into its original position. This surgery is typically approached through the vagina, but in some cases, it can be done through the abdomen. This may be done by grafting the patient's own tissue, donor tissue, or synthetic material in the weekend pelvic floor tissues. This will provide support to the weekend pelvic structures.

How to Prevent Uterine Prolapse?

Preventing uterine prolapse is not always possible, but there are many ways to reduce the risk of developing uterine prolapse. A few lifestyle variations that can reduce the risk of prolapse include:

• Maintaining a healthy body weight.

• Kegel exercises strengthen the pelvic floor muscles, so perform them regularly. It is important to consult a healthcare provider before starting any exercise program.

• It is essential to have a healthy diet to treat and prevent constipation. Drink plenty of water and eat high-fiber foods like vegetables, fruits, beans, and whole-grain cereals. Consult a nutritionist for the best diet plan to maintain a healthy weight.

• Take treatment for coughing or respiratory disorders. Avoid smoking which can also cause severe cough.

• Use proper lifting techniques and avoid heavy lifting. Use the legs instead of the back or waist when lifting heavy weights.

Conclusion:

Uterine prolapse can occur due to many reasons, but old age is one of the most common etiology. In most cases, uterine prolapse does not cause any symptoms, but in severe cases, the symptoms can arise, which cause pain and discomfort, and other complications. Consult a physician when symptoms arise.