Uterine prolapse is one of those conditions that is the result of wear and tear on a woman’s body. Aging and multiple childbirths are often contributing factors, but as with most health conditions, lifestyle choices and our regular habits that lead us progressively towards or away from wellness definitely play a role. Maybe if we take the time to learn a bit about this malady, we can avoid it in the future, or at least make some changes that can minimize or reverse it in the present.
What is Uterine Prolapse?
The dictionary defines “prolapse” as a state of “falling or slipping out of place.” Uterine prolapse thus involves the dropping of the uterus from its normal position in the pelvis down into the vaginal area. The uterus is designed to be held in place by what could be called a “hammock” of supportive tissue composed of muscles and ligaments. This structure is referred to as the “pelvic floor.” If the pelvic floor is compromised, the uterus is unable to maintain its intended position, and it descends into the vaginal canal. It obviously does not belong there, and a number of problems can result when this occurs.
The most common factors involved in uterine prolapse are age and childbirth. The severity of uterine prolapse can vary from minimal cases that may never even be diagnosed, to serious cases that can make a woman’s life quite unmanageable. Options for treatment include support devices, special exercises, and even surgical procedures that are appropriate for some individuals.
What Are the Symptoms of Uterine Prolapse?
Signs of uterine prolapse vary greatly from patient to patient. In minor instances of prolapse, a woman may not even know she has it, and is totally without symptoms. The more advanced the case is, the more symptoms that are present, and to a greater degree. Some potential symptoms include:
- Pain in the lower back, pelvis, groin, and/or lower abdomen
- Sense of “pulling” or unusual “heaviness” in the pelvic region
- Tissue visibly protruding from the vagina, sometimes irritated and sore, producing ulcers
- Painful intercourse, along with urine leakage and difficulty experiencing orgasm
- Vaginal discharge
- Sense of “sitting on a ball”
- The feeling that something is about to fall out of the vagina
- Incontinence that worsens with effort, such as during heavy lifting, sneezing, laughing, or coughing
- Inability to completely empty the bladder
- Frequent Urinary Tract Infections (UTIs)
- Frequent urge to urinate with little production
- Difficulty having bowel movements
- Finding it necessary to push your fingers into the pelvic region in order to successfully have a bowel movement or empty your bladder
As you can see, dealing with uterine prolapse can be quite discomforting and painful at times, depending on the severity of the condition. Many women report that the symptoms can be much worse after standing all day, and are generally not as bad in the morning after being in a lying down position overnight. Obviously gravity is a factor as well.
What Are the Most Common Causes of Uterine Prolapse?
Childbirth, especially difficult deliveries or multiple vaginal deliveries, are probably the biggest factors that lead to uterine prolapse. Here is a list of other common causes:
- Giving birth to unusually large babies can stretch the tissues of the pelvic floor and contribute to uterine prolapse later in life. This is especially true if it happens more than once.
- Age itself is also a factor. As we get older, our skin naturally gets less elastic and finds it more difficult to rebound back to its original shape. This can happen just as easily to internal organs as it can on our face.
- Constipation, which typically leads to a pattern of straining during bowel movements, can also contribute to uterine prolapse. Constipation can be a cause, and is also a symptom of existing uterine prolapse in some women as well. It results in strain to the pelvic muscles, which eventually causes them to be less supportive.
- Heavy lifting, especially when it is repeated regularly over long periods of time, can also play a role. One study showed a marked increase in the incidence of uterine prolapse in women who did heavy lifting or performed heavy physical labor during pregnancy or shortly after giving birth. This is a more common occurrence in labor intensive third world countries than here in the United States.
- Trauma, either from a one time incident or sometimes trauma that is repeated over time, can eventually lead to uterine prolapse. An example would be the jarring effects of jogging on a hard surface on a regular basis.
- Post-menopausal women also have a greater risk of developing uterine prolapse because hormonal changes can cause muscles to lose their tone and elasticity, and the skin of the pelvic floor tends to grow thinner and dryer as well, making it more susceptible to damage.
- Genetics also are involved to some degree, although the research on this factor is incomplete at this point in time. Statistics do tell us that uterine prolapse is more common amongst women with Northern European backgrounds than it is for Asian or African women.
- Pelvic tumors are responsible for a small percentage of uterine prolapse cases.
- Obesity causes the entire body to work harder, and may strain pelvic muscles and lead to uterine prolapse. In addition, many obese women suffer from chronic constipation which can also be a factor in prolapse.
- Chronic coughing can definitely take its toll on the strength of the pelvic floor. One of the most common diseases associated with the incidence of uterine prolapse is Chronic Obstructive Pulmonary Disease (COPD). One of its major symptoms is a chronic cough. Smokers who have a chronic cough are also more likely to develop prolapse, as well as sufferers of chronic bronchitis.
What Complications Can Occur From Uterine Prolapse?
In advanced cases, the fallen uterus can actually protrude from the end of the vaginal canal, and at times it can become so irritated that sores or ulcers can form from the friction of this tissue on the thin, sensitive walls of the vagina. In a small percentage of cases, infection can also be a problem. This can lead to a foul smelling discharge and a good deal of pain for some individuals.
Another potential complication is the prolapse of other organs as the pelvic support tissues deteriorate. If the bladder drops down into the vagina, the condition is known as a cystocele, and can contribute to urinary tract infections and urination problems. A rectocele is the name given to a prolapsed rectum, and chronic constipation along with hemorrhoids can result. Both rectal and bladder prolapses can be troublesome enough on their own, but they also tend to aggravate uterine prolapse as well.
What Treatments Are Available for Uterine Prolapse?
One of the good things about this medical condition is that there are several non-invasive treatment options that can be very helpful to many women who suffer from prolapse. When deciding how to deal with your uterine prolapse, you may want to consider just how much the condition is interfering with your life. If your symptoms are minor, and it is not causing you a great deal of trouble, there are exercises available that can strengthen your pelvic floor, and also help the problem from getting worse. More advanced cases can often be resolved with a supportive device called a pessary. Severe cases of uterine prolapse may require surgery. Let’s take a look at each of these options in more detail:
- Kegel exercises are composed of a simple routine that strengthens the muscles of the pelvic floor. They can be used to help reverse minor uterine prolapse, or as a preventative measure, often used after a woman has given birth. Contract the pelvic muscles as if you were trying to stop urinating. Tighten the muscles for 5-10 seconds, and then release. Repeat this ten times, and do four sessions of 10 every day. Kegel exercises are especially useful when combined with lifestyle changes that may include losing weight if necessary, and dealing with any condition or habit that may cause you to have a chronic cough, such as smoking or chronic bronchitis. It is also helpful to learn proper lifting techniques if and when you must do any heavy lifting.
- The use of a pessary is another minimally invasive option that can potentially help sufferers of uterine prolapse. This is a device that is placed inside the vagina to give extra support to the uterus. It must be specially designed to fit your body properly, and can be a temporary or permanent application. It is most appropriate for mild to moderate prolapse, and will have little effect in severe cases. Some women find that it works great for them, others have a lot of trouble. Common problems include difficulty having sexual relations, irritation from the pessary that causes sores or ulcers to develop, and sometimes a foul-smelling odor that occurs. Some pessaries can be removed by the patient and cleaned before being reinserted, while others require your healthcare provider to remove and insert them.
- Surgery is the final option, and often the only one that can help the most severe cases. However, there are a lot of factors to consider before choosing surgery.
You must weigh your own personal situation. Having surgery may make it impossible for you to bear any more children, especially if the uterus is removed. Sometimes a hysterectomy (removal of all or part of the reproductive organs) is involved in uterine prolapse surgery. Another consideration is that if the uterus is preserved intact, and the pelvic floor is simply strengthened through surgically grafting in additional support tissues, this may all be undone if you bear another child. There are also different techniques that can be used during surgery. Vaginal surgery is more invasive than abdominal surgery, but it is also often more effective than the less invasive abdominal option. I would carefully weigh all the possibilities and get the advice of several different health care providers before submitting to any form of surgery.
As with all health care decisions, choose carefully the best way to proceed. Surgery may seem like a quick fix, but making long-term lifestyle changes may give you the best hope for successfully dealing with uterine prolapse and improving your overall health and wellness to boot.