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What is Prolapse of the uterus?
The uterus (womb) is normally held in place by various muscles, ligaments and tissue. Uterine prolapse occurs when the supporting muscles supporting are damaged or become weak and the uterus cannot stay in place. This results in the uterus slipping down from its normal position. Uterine prolapse is graded into the following degrees of severity:
First-degree prolapse - the uterus descends or drops into the vagina.
Second-degree prolapse - part of the uterus sticks out of the opening of the vagina.
Third-degree prolapse - known as procidentia, when the whole uterus is outside the vagina
Symptoms,
Some women with a prolapsed uterus do not suffer any symptoms. In some the problem is only discovered when they have an internal examination. However for many women uterine prolapse is uncomfortable and sometimes very painful. Most women with prolapse of the uterus will experience a feeling of fullness or pelvic heaviness, some report a feeling that something is "coming down" or out of the vagina. In second and third degree prolapse the uterus can actually be seen.
Women with uterine prolapse report:
Lower back pain and backache
Difficulty going to the toilet, constipation
Stress incontinence leaking small amounts of urine when coughing, sneezing or during exercise
Cystitis, including pain and stinging when passing urine
Difficulty walking
Pelvic pain and discomfort during sexual intercourse.
What causes Prolapse of the uterus?
Some degree of prolapse affects up to 30% of women who have had children. Some of the following can result in a prolapsed uterus:
Childbirth - especially if labour was particularly long or difficult, or the baby was large.
The Menopause - hormone changes can cause a weakening and loss of muscle tone.
Weakened pelvic floor muscles - this may be due to aging or because of heavy lifting and straining.
Being overweight - Extra weight creates pressure on the pelvic floor and abdominal area.
Any pelvic surgery, such as hysterectomy or bladder surgery.
Constipation - long term chronic constipation results in straining.
Respiratory problems with a long-lasting, chronic cough.
Treatment
Prolapse of the Uterus is treated in many ways, according to the severity, the womans age and heath and whether she wants more children. A mild to moderate prolapse that is not causing pain won't need treatment. However there are things that a woman can do to improve her prolapse and prevent it from worsening, these include:
Avoid standing for long periods of time.
Eat a high fibre diet with plenty of fresh fruits, vegetables and wholegrain bread and cereal, to prevent constipation and reduce straining.
Perform regular pelvic floor exercises. These help strengthen weakened muscles, aid recovery after pelvic surgery, and will reduce symptoms like leaking urine and backache.
If a woman is going through the menopause her Doctor may recommend HRT hormone replacement treatment. Check out alternative ways to support menopausal transition, see our articles by Maryon Stewart who advocates a HRT free menopause.
Vaginal pessaries. Similar to a diaphragm or cap vaginal pessaries are inserted into the vagina to support the uterus in place. The vaginal pessary will be removed every three to six months by a Doctor or Healthcare professional; and replaced with a new one.
Surgery
For women who want more children there are two types of surgery to treat a severe prolapse of the uterus. The operation aims to hold the uterus in place in one of two ways:
Sacrohysteropexy. - A synthetic mesh holds the uterus in place.
Sacrospinous fixation. - The uterus is stitched to one of the pelvic ligaments.
For women who do not want more children the removal of the uterus is considered the most effective treatment for prolapse of the uterus, this is called a hysterectomy.
Hysterectomy. - The removal of the uterus or womb surgically. However even after a hysterectomy and the removal of the uterus a women is at increased risk of another prolapse - vaginal vault prolapse. Because the uterus provides support for the top of the vagina, this condition is common after a hysterectomy, with upwards of 10% of women developing a vaginal vault prolapse after undergoing a hysterectomy. In vaginal vault prolapse, the top of the vagina gradually falls toward the vaginal opening. This may cause the walls of the vagina to weaken as well. Eventually, the top of the vagina may protrude out of the body through the vaginal opening, effectively turning the vagina inside out. A vaginal vault prolapse often accompanies an enterocele (prolapse of the small bowel).
Prevention
To reduce the risk of uterine prolapse, or prevent it from worsening a woman should do the following:
Avoid standing for long periods of time.
Eat a high fibre diet with plenty of fresh fruits, vegetables and wholegrain bread and cereal, to prevent constipation and reduce straining.
Do regular pelvic floor exercises. These help strengthen weakened muscles, aid recovery after pelvic surgery, and may reduce symptoms like leaking urine and backache.
Lose weight and maintain a healthy weight
Avoid heavy lifting and straining.
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