Q1. What is uterine prolapse?
Uterine prolapse occurs when the pelvic floor muscles and tissues weaken and no longer provide enough support for the uterus. This causes the uterus to descend from its normal position and may even protrude into or out of the vagina, creating a “lump”. This condition, also known as “pelvic organ prolapse”, can affect not only the uterus but also the bladder and rectum, which rely on the pelvic floor for support. These organs may slip down and bulge into the vagina when they are no longer supported by the pelvic muscles and tissues.
Q2. Why does uterine prolapse occur suddenly? Who is at high risk?
When the pelvic muscles and ligaments become loose, the uterus, bladder or rectum may descend into the vagina. Major causes of weakened pelvic muscles include pregnancy and childbirth, especially multiple vaginal deliveries, prolonged labour or assisted delivery with forceps, which can cause injury to the pelvic muscles and ligaments. These are high-risk factors. Muscles and tissues may also shrink and weaken with age. During menopause, the tissues are further weakened due to the lack of hormones. Pressure in the abdomen from factors such as being overweight, smoking, chronic cough, frequent constipation and long-term heavy lifting can also increase the risk of prolapse. Family history can also affect the elasticity of the fibres. If a family member has a history of genital prolapse, one’s risk of developing prolapse also increases.
Q3. What are the symptoms of uterine prolapse?
The symptoms of uterine prolapse are usually less bothersome in the morning or when one wakes up. When one gets busy throughout the day, the symptoms can become more noticeable in the afternoon and evening. Common symptoms include a feeling of heaviness in the pelvis, or even a bulge or lump on the outside of the vagina, which are caused by the uterus, bladder or rectum dropping down through the vagina. This is not a tumour. Prolapse of the bladder and rectum can also cause frequent urination, urinary incontinence or difficulty in urination or defecation. Some patients may even need to manually push the bulge back into the vagina before they can urinate or defecate. Uterine prolapse can also make intercourse difficult. As the prolapse worsens, the protruding part may rub against clothing and cause skin ulcers or even bleeding.
Q4. What are the treatments? Can it be treated without surgery?
The diagnosis and treatment of genital prolapse, including prolapse of the uterus, bladder and rectum, depend on the severity of the prolapse and its symptoms. Mild prolapse with mild symptoms may require observation without treatment. However, non-surgical or surgical treatment may be necessary if the condition worsens.
Non-surgical treatments include pelvic floor exercises, which can strengthen the pelvic floor muscles under the guidance of a physiotherapist. Another option is the use of a vaginal pessary, a device that is inserted into the vagina to provide support and maintain the normal position of a prolapsed uterus or bladder. Made of plastic, a pessary is placed inside the vagina and changed regularly by doctors.
For more severe cases, surgery may be considered. The most conventional and common surgical procedure is vaginal hysterectomy, which involves removal of the prolapsed uterus through the vagina. It can also tighten the tissues and muscles of the pelvic floor to regain support to and lift the organs back into place, thereby restoring bladder and bowel functions.
Q5. Is uterine prolapse preventable? Can it be improved by exercise?
As the specific causes of uterine prolapse are not fully understood, there is no definitive way to prevent the condition. However, certain high risk factors can make it more likely to develop or deteriorate. These factors include being overweight and conditions that increase pressure in the abdomen and exacerbate the condition, such as smoking, chronic cough, constipation and frequent heavy lifting. Thus we should pay attention to our lifestyles. To begin with, maintaining a healthy weight and avoiding excess weight is crucial. Additionally, adhering to a balanced diet with increased intake of fiber-rich foods such as vegetables and fruits can help prevent constipation. It is also essential to quit smoking and seek medical advice if experiencing chronic cough.
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