What is going on with your stomach?
Over the past several months, you’ve noticed that your lower abdomen has a heaviness sensation that seems to be getting worse. In the past few weeks, you started leaking urine when you cough or sneeze. You go to the doctor to get check out, and she tells you that you have a uterine prolapse. What is this? How can it be fixed? Are there ways to prevent it?
Definition
Uterine prolapse happens when the pelvic muscles and supportive tissues (ligaments) weaken and stretch, which means they no longer support the uterus. The result is the uterus slipping down into the vagina or protruding from the vagina. While it can occur at any age, it most often affects postmenopausal women who’ve had one or more vaginal deliveries. The causes of uterine prolapse are pregnancy, difficult labor and delivery or trauma during childbirth, delivery of a large baby, being overweight/obese, lower estrogen level after menopause, chronic constipation or straining with bowel movements, chronic cough or bronchitis, or repeated heavy lifting. Besides these, other risk factors are prior pelvic surgery, family history of weakness in connective tissue, and being white or Hispanic.
If the uterine prolapse is mild, there aren’t usually any symptoms. Moderate to severe uterine prolapse symptoms can include a sensation of heaviness/pulling in your pelvis, tissue protruding from your vagina, urinary problems (incontinence or retention), trouble having a bowel movement, feeling as if you’re sitting on a small ball or as if something is falling out of your vagina, and sexual concerns (a sensation of looseness in the tone of your vaginal tissue). Often, symptoms get worse as the day goes on. Severe uterine prolapse can displace part of the vaginal lining, causing it to protrude outside the body. If this happens, the vaginal tissue can rub against clothing leading to vaginal sores (ulcers). Rarely, these sores become infected.
Uterine prolapse is often seen with the prolapse of other pelvic organs. Anterior prolapse (cystocele), or bladder prolapse, is when the weakness of connective tissue separating the bladder and vagina causes the bladder to bulge into the vagina. Posterior vaginal prolapse (rectocele) happens when the weakness of connective tissue separating the rectum and vagina results in the rectum protruding into the vagina.
Treatment
Uterine prolapse treatment depends on the severity of the condition. If your symptoms aren’t that bad, your doctor will recommend lifestyle changes that are also considered preventative techniques, so we’ll look at those in the next section. Another option is a vaginal pessary. This is a plastic or rubber ring inserted into your vagina to support the bulging tissue. It must be removed regularly for cleaning, which your doctor typically does.
If your symptoms are severe, your doctor may advise that you have surgery. One option is to repair the weakened pelvic floor tissues by using a graft of your own tissue, donor tissue, or synthetic material and attaching it to the weakened pelvic floor structures to support your pelvic organs. This surgery is generally approached through the vagina but sometimes through the abdomen. The other option is a hysterectomy. While it’s usually very safe, it does pose the risk of complications and long-term side effects.
Prevention
There are steps you can take to try to reduce your chances of having uterine prolapse. One of the best things is to perform Kegel exercises regularly. They can strengthen your pelvic floor muscles. This is especially important after you have a baby. To perform Kegel exercises, you should tighten (contract) your pelvic floor muscles as though you were trying to prevent passing gas. Hold this for five seconds, and then relax for five seconds. If this is too challenging, start by holding for two seconds and relaxing for three seconds. Your goal should be to work up to holding the contractions for 10 seconds at a time. You want to aim for at least three sets of 10 repetitions each day.
Another essential step is to treat and prevent constipation because this will help you reduce straining when trying to pass a bowel movement. You can do this by drinking plenty of water and eat high-fiber foods, like fruits, vegetables, beans, and whole grains. Also, avoid heavy lifting. If you need to lift anything, especially if it’s heavy, do so correctly by using your legs instead of your waist or back. Make sure to get treatment for a chronic cough or bronchitis, and don’t smoke. Avoid weight gain by eating a healthy diet and getting regular exercise.
Uterine prolapse is definitely an uncomfortable experience at a minimum. However, with the proper treatment, the symptoms will go away. If you have any questions or concerns about uterine prolapse, please speak with your doctor. If you would like more information, please visit Medline Plus’ Uterine Prolapse page at https://medlineplus.gov/ency/article/001508.htm