UTERINE PROLAPSE PART 1

The uterus (womb) is a muscular structure held together by pelvic floor muscles and ligaments. Pelvic floor muscles are the muscles, ligaments, and tissues in the pelvis (area of the body below the abdomen). The uterus, bladder, vagina, rectum (part of the large intestine terminating at the anus), and other pelvic organs are all supported by these muscles. When the pelvic floor muscles are damaged or weakened to the point where they can no longer provide support, a prolapse occurs.

Uterine prolapse occurs when the pelvic floor muscles and ligaments stretch and weaken due to pregnancy, childbirth or difficult labour to the point where they can no longer support the uterus. As a result, the uterus descends and enters or protrudes from the vagina.

Uterine prolapse is most common in women who have had one or more vaginal deliveries after menopause due to the natural loss of the hormone estrogen. Uterine prolapse can be mild or severe, depending on how weak the uterine supporting muscles have become. Normal activities can be disrupted and made uncomfortable by uterine prolapse. Very mild cases may not necessitate treatment or cause any discomfort. However, severe cases may make it difficult to pee or have a normal bowel movement. Uterine prolapse is typically a quality of life issue, and healthcare providers treat it when symptoms begin to interfere with daily life.

STAGES OF UTERINE PROLAPSE

Uterine prolapses are classified as either incomplete or complete.

• Incomplete Uterine Prolapse – In an incomplete uterine prolapse, the uterus partially displaces the vagina but does not protrude and may lead to a lump.

• Complete Uterine Prolapse – In a complete uterine prolapse, a portion of the uterus protrudes from the vaginal opening. The introitus is another name for this opening.

Muscle weakness may cause your uterus to sag or completely exit your body in stages. The severity of this condition is graded into:

1. First Degree: The cervix (opening/neck of the womb) drops into the vagina.

• Second Degree: The cervix descends to the level just inside the vaginal opening.

• Third Degree: The cervix is outside the vagina.

• Fourth Degree: The entire uterus is outside the vagina leading to a condition known as Procidentia. That is, the lack of strength in all of the supporting muscles.

CAUSES OF UTERINE PROLAPSE

The following are some of the causes of weakened pelvic muscles and tissues:

• Vaginal birth

• Age at first delivery (older women are at higher risk of pelvic floor injuries compared with younger women)

• Difficult labor or childbirth trauma

• Being overweight or obese during childbirth

• Lower estrogen levels following menopause leading to loss of muscle tone

• Constipation or straining with bowel movements on a regular basis

• Bronchitis or chronic cough

• Smoking

• Heavy weight lifting on a regular basis

• History of pelvic surgery (hysterectomy)

• Genetic factors that cause connective tissue weakness

SYMPTOMS OF UTERINE PROLAPSE

Mild uterine prolapse is quite common following childbirth. It usually does not cause any symptoms. The following are symptoms of moderate to severe uterine prolapse:

• Vaginal tissue weakness

• Vaginal bleeding

• Increased discharge issues during sexual intercourse

• Recurring bladder infections, constipation or difficulty passing stool

• Lower back ache

• Feeling of the vaginal tissue rubbing against clothing

• Walking in pain

• Having difficulty inserting tampons or other vaginal applicators.

• Feeling as if the bladder does not completely empty when you use the restroom

• Urine leakage issues, also known as incontinence

• Having the sensation of sitting on a small ball

• Having difficulty having a bowel movement and needing to press the vagina to have one

• Seeing or feeling tissue protrude from the vagina

• Feeling heaviness or a pulling sensation in the pelvis

Standing, walking for long periods of time, coughing or sneezing may worsen symptoms as gravity puts extra pressure on the pelvic muscles in these positions. The condition may impair bowel, bladder, and sexual function if not treated properly.

COMPLICATIONS OF UTERINE PROLAPSE

Uterine prolapse is frequently associated with prolapse of other pelvic organs. These types of prolapse could also occur:

• Prolapse of the anterior uterus – Anterior prolapse is caused by a lack of connective tissue between the bladder and the vaginal roof. It has the potential to cause the bladder to bulge into the vagina leading to frequent urination, retention, urgency and incontinence. This is referred to as a cystocele or a prolapsed bladder.

• Prolapse of the posterior vaginal wall – Weak connective tissue between the rectum and the vaginal floor can cause the rectum to protrude into the vagina. This could make bowel movements difficult. Another term for posterior vaginal prolapse is called rectocele.

• Herniation of the upper rear vaginal wall – This occurs when a small portion of the bowel bulges into the vagina. Standing causes a pulling sensation and backache, which may be relieved by lying down. Herniation of the upper rear vaginal wall is also known as enterocele.

Ulceration (open sore) of exposed tissue and prolapse of other pelvic organs, such as the bladder or rectum are also common complications ……………………………………………………………TO BE CONTINUED