When pelvic organs including uterus, bladder, bowel(rectum) descend through the vaginal introitus it is called prolapse. As a result uterus slips down or protrudes out of the vagina.
Many older women who experience this usually are hesitant to see the doctor and live with it for years together suffering through the morbidity but there is always a solution to it which can be addressed very efficiently. Surgical treatment can improve the quality of life in such women.
Uterine prolapse is associated with descent of the bladder called cystocele, descent of the bowel which is called rectocele(rectum ). It is graded into four grades depending on the descent of the organs through the vagina. Fourth grade of descent is also known as Procidentia.
Causes
Uterine prolapse can occur at any age , However it is more common in older women who are postmenopausal because it is due to the weekened pelvic muscles and tissues which could be due to Multiple pregnancies at short intervals prolonged labour or difficult delivery including instrumentation delivery of a big baby, heavy weight lifting, chronic constipation,chronic cough, obesity, oestrogen deficiency after menopause.
Symptoms
- Mass or tissue protruding through the vagina
- Foul smelling discharge
- Heaviness in the pelvis
- Urinary symptoms like in complete emptying of bladder, frequent micturition, leaking on stress or cough
- Bowel symptoms like in complete defecation or constipation
- Sexual dysfunction
- Vaginal flatus
Diagnosis
It is made by simple pelvic exam. the associated bladder leak is elicited by coughing test. the strength of the pelvic muscles is assessed by asking you to tighten the pelvic muscles. Your doctor might ask you to do a simple ultrasound abdomen and pelvis to look at the presence of swelling in the kidneys or ureter (hydroureteronephrosis) which could be because of the prolapse.
Treatment
Milder degrees of you can collapse could be treated with keys and 60 phases to strengthen your pelvic muscles losing weight and treating constipation if present.
Surgical management would be recommended only if there is 3rd° or 4th° descent along with other problems Surgery involves two important components repair of the pelvic floor- anteriorly the bladder supports are repaired and posteriorly bowel supports are repaired removal of uterus - vaginal hysterectomy is generally very safe.
Prevention
- Adequate amount of pelvic floor strengthening following delivery through exercises most importantly Kegel’s exercises
- Avoid chronic constipation ,drink lots of water and eat high-fibre foods
- Avoid straining while passing stools
- Avoid chronic cough or bronchitis
- Avoid heavy weightlifting
- Lose weight if you are obese
Kegel Exercises
Keble exercises strengthen your pelvic floor muscles. It is best done just after emptying the bladder stand up bend forward putting your torso parallel to the floor and tighten your pelvic muscles like you are trying to hold the bladder and trying to prevent passing gas hold the contraction and count up to 10 and then relax again, contract count up to 10 and then relax do this for about 8 to 10 times at a time. Aim for at least three sets of 10 repetitions every day.