Uterine Prolapse – Symptoms, Diagnosis and Treatment

Uterine or prolapse of the uterus is a clinical condition when the uterus of a woman drops down into the cervix or vagina or even protrudes outside of the vagina. With age, the muscles in the pelvis region (and across the body) become weak. As a result, they lose the capacity to hold the soft organs including the uterus in its place. As the grip on the uterus drops, it starts descending down resulting in Uterine Prolapse.

Depending on how much the uterus has dropped into the vagina, uterine prolapse is categorized into 2 stages.

1. Incomplete Uterine Prolapse – Where the uterus drops partially into the vagina but doesn’t protrude outside of it.
2. Complete Uterine Prolapse – A portion of uterus is visible outside the vagina.

Depending on the severity of uterine prolapse, it has been graded into 4 different grades. Let’s leave those details to the doctors.

Symptoms of Uterine Prolapse

1. As the uterine drops into the vagina, a bulge or feeling of fullness will be experienced in the abdomen region.
2. Vaginal bleeding or discharge may also be seen.
3. As the vagina gets blocked, it becomes difficult having sexual intercourse.
4. Bowel movement will be affected
5. Pain in lower back may be experienced.
6. In complete uterine prolapsed cases, the person can see and feel the uterus coming out of their vagina.
7. A feeling of sitting on a ball.

What causes Uterine Prolapse?

1. Major cause of uterine prolapse is due to the pelvic muscles getting weaker. How and why do the pelvic muscles become weak?
   1. Pregnancy – When a woman is carrying a baby, as the baby grows, it lays tremendous pressure on all parts in the pelvis region. The muscles and tissues gets stretched.
   2. Vaginal Delivery – A highly traumatic condition. During the vaginal delivery of a baby, many tissues and muscles tear. In cases when the baby is larger than usual, the damage caused is even higher. Vagina and all the muscles and tissues have the ability to retract and get back to their original position but owing to the amount of damage caused, they will not be able to get back 100% of their original strength or tightness.
   3. Age – As a person ages, all the muscles become weak.
2. Lifting heavy weights consistently in a wrong way. Weights are to be lifted with maximum pressure on the legs but not on the abdomen or lower back. If the pressure is consistently laid on pelvis or lower back region, the muscles tear and become weak.
3. Constipation – How difficult it is to pass stools can be understood only by those who are suffering from constipation. The amount of pressure laid to push out the stool can result in tearing or damaging the tissues in the pelvis region.
4. Pelvic Surgeries – When an incision based surgery is performed in the pelvis region, many muscles or tissues are cut. They may not get back to their original strength or shape after healing, resulting in weakness. If there are a series of surgeries to be performed in that region for any reason, the muscles become totally weak resulting in pelvic organ prolapse and uterine prolapse is just one among them.
5. Chronic cough – A long term cough. When a person coughs, it puts little pressure on the pelvis area; you can feel it when you touch the perineum area of a coughing person. Continuous and long term cough can damage the soft tissues in this region.

How is uterine prolapse diagnosed?

When you present yourself to your gynecologist with any of these symptoms, the first thing that would be performed is a physical examination of the pelvis region.

If your doctor suspects (when not obvious) uterine prolapse, you may be advised to get Ultrasound or an MRI done. Depending on the position of the uterus, your doctor can suggest the appropriate treatment.

Treating Uterine Prolapse

Depending on the degree/grade of uterine prolapse, your doctor will talk to you about the treatment options. Some options may be expensive and some may be less expensive depending on the stage of uterine prolapse you have.

1. Vaginal Pessary – This device is inserted through the vagina and it helps in keeping the uterus in its position. Learn well about the care you need to take when inserting, removing and keeping the device clean. If the pessary is causing problems when having sex, please talk to your gynecologist.
2. Surgical options for Uterine Prolapse:
   1. Trying to fix the uterine in its place using skin grafting or donor tissues or other materials. This is done in women who want to retain their uterus for any reason, may be their religious faith or if they are planning a baby etc.
   2. Hysterectomy – Widely performed procedure to remove the vagina. Hysterectomy is performed in women who are not expecting to become pregnant in the future. This can be done either through the vagina or using advanced laparoscopic procedure. Robotic hysterectomy is quickly gaining pace and Dr. Deepa Ganesh is one of the pioneers in South India in this area.

Remedies for Uterine prolapse

1. If you are lifting heavy weights in a wrong way, get a trainer or talk to someone experienced to figure out and practice the right posture.
2. Pelvic muscle weakening due to pregnancy and child birth may be fixed to an extent with Kegels exercise. Practice regularly every day, you can surely control minor symptoms such as urine leakage/incontinence etc.
3. If you are suffering from constipation, add more water, fibre to your diet. Talk to a gastroenterologist to get your problem fixed.
4. Chronic Cough – Get this checked by a chest specialist and use appropriate medication.
5. Depending on your condition, hormone replacement therapy (HRT) may be an option for you.

References

1. http://www.merckmanuals.com/professional/gynecology-and-obstetrics/pelvic-relaxation-syndromes/uterine-and-vaginal-prolapse
2. https://www.mayoclinic.org/diseases-conditions/uterine-prolapse/symptoms-causes/syc-20353458