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Uterine prolapse happens when the muscles and ligaments of the pelvic floor become weak and unable to hold up the uterus. The uterus then prolapses through the vaginal canal and sometimes becomes outside the body. It is relatively common in women who have had one or more vaginal deliveries and who are postmenopausal. The cause is damage to supportive tissues during childbirth and pregnancy, loss of supportive estrogen, the effects of gravity and straining at stooling. These all weaken the pelvic floor and cause uterine prolapse.
Mild uterine prolapse does not need to be treated but can be managed using Kegel exercises. If the prolapse hurts or interrupts your normal life activities, you may benefit from some sort of treatment, including a pessary device or a surgical repair.
Symptoms of a uterine prolapse includes a sensation of pulling or heaviness in the pelvic region, urinary leakage or urinary retention, the cervix protruding from the vagina, having problems with bowel movements, having low back pain, feeling like something is falling out of the vagina, or sexual difficulties. Symptoms you notice are less in the morning and worsen throughout the day.
The cause of uterine prolapse is usually related to pregnancy and delivery trauma. If you have large babies or a difficult labor, you can have the chance of having uterine prolapse. There can be a loss of muscle tone secondary to the aging process and when there is less circulating estrogen. If you have a tumor of the uterus, such as a fibroid tumor, this can increase the weight of the uterus and can increase the chances of uterine prolapse.
Heredity also plays a role in whether or not you have strength in your pelvic floor. It is more common in Northern European descent and less common in Asian or African women.
Certain factors can play a role in your getting uterine prolapse. If you have one or more vaginal births, you are at higher risk. Being of a higher age or frequent heavy lifting can increase the chances of uterine prolapse. Having a chronic cough can increase the chances and straining during stools can increase the risk. Having a large baby can make uterine prolapse worse. Genetic relaxation of connective tissue makes the likelihood of having prolapse higher.
Doctors can diagnose a uterine prolapse through a thorough history and physical. A pelvic exam will tell if there is prolapse, especially if it is done when you are standing or straining. You may be asked to tighten your pelvic muscles to see how strong they are. You need to tell your doctor what kinds of symptoms are plaguing you because of uterine prolapse. An MRI exam can show if there are fibroid tumors on the uterus. An ultrasound can also tell if there are uterine fibroids.
The treatment of uterine prolapse can be losing weight and getting help for frequent coughing. This can slow the progression of the disease. Kegel exercises can help with increasing the strength of the muscles of the pelvic floor. These can be done several times a day and will keep the pelvic floor strong. Avoid any type of heavy lifting or straining, by taking laxatives to reduce the incidence of constipation.
A pessary can be used to keep the uterus up. It is a doughnut shaped rubber or plastic object that fits behind the pubic bone to keep the uterus up. There are other shapes as well. The doctor fits you for the right size of pessary and you wear it during the day or all around the day to prevent a urinary prolapse. It should feel completely comfortable to wear if it is a normal position within the vaginal vault. A pessary will work for mild to moderate prolapse but will not work for severe prolapse. A pessary can also interfere with normal sexual activities.
Surgery can be done to repair a vaginal prolapse. Surgery can be done which spares the uterus and helps suspend the uterus within the pelvis. If no childbearing is desired, you need to have a hysterectomy to repair the prolapse. This is the only good treatment for severe vaginal prolapse.
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