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Uterine prolapse

Definition


Disease: Uterine prolapse Uterine prolapse
Category: Gynecological diseases

Disease Definition:

When the uterus descends from its normal position in the pelvis farther down into the vagina, it is a condition called uterine prolapse. In normal cases, the muscles and ligaments that make up the pelvic floor hold the uterus in its place. However, when these ligaments and muscles become stretched and weakened, they won't provide an adequate support for the uterus. This will cause the uterus to descend into the vaginal canal. In most cases, this condition occurs in postmenopausal women who've had one or more vaginal deliveries. The pelvic floor muscles and the tissues may become weakened and so lead to uterine prolapse due to loss of estrogen, the effects of gravity, repeated straining over the years and the damage that is sustained during pregnancy and childbirth. A mild uterine prolapse usually doesn't require any treatments. However, treatment may be beneficial in case the condition disrupts the patient's normal life and makes her uncomfortable. Two of the treatment options for this condition are undergoing surgery to repair the prolapse, or using a supportive device (pessary) that is inserted into the vagina.
 

Work Group:


Symptoms, Causes

Symptoms:

The severity of uterine prolapse ranges from mild to moderate to severe. In its moderate to severe cases, uterine prolapse may cause some of these signs and symptoms:

  • Low back pain
  • Urge incontinence, urine leakage or other urinary difficulties
  • A feeling of heaviness or pulling in the pelvic
  • Symptoms that are less bothersome in the morning and become worse as the day progresses.
  • Trouble having a bowel movement
  • Tissue that protrudes from the vagina
  • Feeling as if something is falling from the vagina or as if sitting on a small ball
     

Causes:

The main causes of muscle weakness and stretching of the supporting tissues that end up causing uterine prolapse are pregnancy and trauma that occur during childbirth, especially if the baby is large or if the labor and delivery are difficult. Uterine prolapse may also be triggered due to the loss of muscle tone that is associated with aging as well as reduced amounts of circulating estrogen after menopause. A tumor in the pelvic cavity may occasionally cause uterine prolapse. Women of African and Asian descent seem to have lower chances of uterine prolapse than those of Northern European descent, meaning that genetics play a role in the development of this condition. Some of the factors that may increase a woman's chances of developing uterine prolapse include:

  • Giving birth to a large baby
  • Chronic coughing
  • Frequent straining during bowel movements
  • One or more pregnancies and vaginal births
  • Frequent heavy lifting
  • Increasing age

 

The muscles and connective tissue in the pelvis may be strained, contributing to uterine prolapse due to some conditions such as chronic constipation, obesity and chronic obstructive pulmonary disease (COPD).
 

Complications

Complications:

Some of the complications that uterine prolapse may end up causing include:

 

Ulcers:

If uterine prolapse is severe, part of the vaginal lining may be displaced by the fallen uterus and become exposed outside the body. Vaginal sores (ulcers) may result from this exposure, and in some cases, these ulcers may become infected.

 

Prolapse of other pelvic organs:

A woman may experience prolapse of other pelvic organs such as the rectum and bladder, in addition to uterine prolapse. A woman will have an increased risk of a cystocele which in turn may lead to an increased risk of urinary tract infections and difficulty urinating in case a prolapsed bladder bulges into the front part of her vagina. Additionally, difficulty having bowel movements may be the result of a prolapsed rectum (rectocele), which in turn is the result of the weakness of the connective tissue that overlies the rectum.
 

Treatments:

The progression of uterine prolapse may be slowed with stopping smoking, losing weight and getting proper treatment for contributing medical problems, such as lung disease with coughing. Treatment for uterine prolapse won't be necessary if it is mild with no symptoms, or if its symptoms aren't too annoying. But in this case, the uterine prolapse may become more severe if the pelvic floor continues to lose tone. Some of the treatment options for uterine prolapse may be:

 

Lifestyle changes:

A doctor may help the patient achieve a healthy weight and maintain it in case she's overweight or obese. Heavy lifting and straining should be avoided. Additionally, in order to relieve some symptoms, exercises to strengthen the pelvic floor muscles (Kegel exercises) may be helpful.

 

Vaginal pessary:

A device that is designed to hold the uterus in place and fits inside the vagina is called a vaginal pessary. This method could be used as a temporary treatment, or a permanent one. The patient will be measured and fit for the vaginal pessary because they come in different shapes and sizes. Additionally, to make sure that the pessary fits, that it won’t become dislodged and that it feels reasonably comfortable, the doctor will ask the patient to walk, sit, squat and bear down. The patient may also return to the doctor’s office in a few days to ensure that the pessary is still in place. This device should be frequently cleaned with soap and water. The pessary can also be removed at night and reinserted at the morning. The doctor should show the patient how to remove and reinsert the pessary. However, this device won’t be much of a help to a woman with severe uterine prolapse. In addition to this, small sores may be caused in case the vaginal pessary irritates vaginal tissues. This device may interfere with sexual discourse, and a foul-smelling discharge will be experienced in case the pessary isn’t frequently removed and cleaned.

 

Surgery to repair uterine prolapse:

Surgical repair may be an option in case a woman doesn’t want to use a pessary, or if other treatments haven’t relieved her from the symptoms of this condition. A vaginal hysterectomy will be done in this procedure, removing the uterus and excess vaginal tissue. In some cases, to support the pelvic organs, surgical repair may be done through a graft of the patient’s own tissue, donor tissue or some synthetic material onto the weakened pelvic floor structures. Vaginal procedures are associated with less pain after surgery, a better cosmetic result and faster healing. Because of this, performing uterine prolapse vaginally is much better. One bad aspect of vaginal surgery is that it won’t last as long as an abdominal surgery. Prolapse may recur in case the uterus isn’t also removed during this surgery. Yet another method of surgical removal is laprascopic surgery, in which smaller abdominal incisions are made. In this type of procedure, the surgeon will use specialized surgical instruments and will be guided by a lighted camera-like device. The surgical repair of uterine prolapse won’t be a good idea if a woman still wants to have kids because the benefits of the surgical repair can be undone due to the strain that pregnancy and delivery puts on the supportive tissues of the uterus. Additionally, it’s better for women with major medical problems to use a pessary than to undergo surgery because anesthesia may pose too great a risk.
 

Prognosis:

Not available

Expert's opinion

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