Uterine prolapse occurs when the ligaments and muscles holding the uterus in place has weakened to allow it to drop out of the vagina especially in a squatting position.
Causes of Uterine Prolapse:
1.Pregnancy and childbirth -the physical trauma of child birth can strain the pelvic muscles and ligaments to the extent that they are not as strong as before childbirth
2.large fibroids or pelvic tumors can cause pressure on the pelvic muscles downward by gravity
3.age and menopause can weaken the pelvic muscles and the elasticity of the ligaments
4.Heavy lifting as in manual work can also strain and damage pelvic muscles
5.overweight women are more prone to prolapse
6.Pelvic or spinal surgery may damage nerves and pelvic muscles increasing the risk of prolapse.
7.Genetic conditions or muscle dystrophy conditions may be responsible for weak muscles
8.Chronic coughing from smoking or the straining due to constipation, increases the risk of prolapse
Symptoms and signs of uterine prolapse are:
1.Heaviness or protrusion out of the vagina
2.Some thing dropping out of the vaginal area
3.Discomfort or pain in pelvis, abdomen or back
4.Vaginal discharge is excessive or unusual
5.Frequency of urination or urine infection
6.Loss of control of urination(incontinence)
Symptoms may be worse in the evening after prolonged standing or walking
Signs of Uterine prolapse are:
1.Physical examination may show a protrusion of the uterus on squatting.
2.Vaginal examination show the degree of uterine prolapse especially in the standing position:
Stage I Descent of the uterus to any point in the vagina above the level of the hymen
Stage II Descent to the level of the hymen
Stage III - Descent beyond the hymen
Stage IV - Total prolapse
3.Ultrasound of the pelvis may exclude other conditions than uterine prolapse
Treatment of Uterine Prolapse :
Conservative usually for mild cases of uterine prolapse:
1.Kegel exercises help to strengthen the pelvic floor muscles.
The patient is asked to tighten the pelvic muscles by tightening the anus for a few seconds and then release many times a day.
2.Vaginal pessary is a rubber or plastic device which is placed around or under the cervix to support the uterus and hold it in position.
Regular removal and cleaning is important to prevent infection.
It is a temporary measure.
Surgery:
This is the more permanent method of treatment.
1.Colpocleisis involves the removal of a part of anterior and posterior vaginal wall and closing of the margins of the two walls resulting in a small vaginal canal.
The uterus is thus unable to drop out of the smaller vaginal canal.
Success is 90-100%.
2.Sacrospinous fixation is a procedure where the uterosacral ligaments bilaterally is sutured to the sacrospinous ligaments preventing the prolapse.
3.Sacrohysteropexy make use of a strip of synthetic mesh to hold the uterus in place in an operation done through a 15-cm incision or laparoscopy. One end of the mesh is attached to the cervix and top of the vagina and the other to the sacrum thus supporting the uterus.
4.Vaginal hysterectomy -the uterus is removed through the vagina and the uterosacral and cardinal ligaments are sutured together.
5.Abdominal hysterectomy is done when there is pelvic inflammatory disease or previous intra-abdominal operation when a vaginal hysterectomy is not advisable. The uterus is removed followed by a vaginal anterior and posterior colporrhaphy.
Prognosis of uterine prolapse indicates the treatment in most cases will relieve the symptoms and discomfort.
Prevention of uterine prolapse :
1.Avoid constipation by taking a healthy diet
2.Pelvic muscle exercise (Kegel exercises) should be done regularly
3.Avoid straing of pelvic muscle by using correct lifting techniques
4.Avoid smoking to prevent a chronic cough
