What causes prolapse of the Uterus ?

[Explained in Emedicinehealth.com's website]

Your Uterus (womb in which a fetus develops) is normally held in place inside your pelvis with various muscles, tissue, and ligaments. Sometimes-because of childbirth or difficult labor and delivery-these muscles weaken. As a woman ages and with a natural loss of the hormone estrogen, her uterus can collapse into the vaginal canal, causing the condition known as a prolapsed uterus.

• Muscle weakness or relaxation may allow your uterus to sag or come completely out of your body in various stages :
  
  
  • First degree : The cervix droops into the vagina.
    
    
  • Second degree : The cervix sticks to the opening of the vagina.
    
    
  • Third degree : The cervix is outside the vagina.
    
    
  • Fourth degree : The entire uterus is outside the vagina. This condition is also called procidentia. This is caused by weakness in all of the supporting muscles.
• 
  
• Other conditions are usually associated with prolapsed uterus. They weaken the muscles that hold the uterus in place :
  
  
  • Cystocele: A herniation (or bulging) of the upper front vaginal wall where a part of bladder bulges into the vagina, which may lead to urinary frequency, urgency, retention, and incontinence.
    
    
  • Enterocele: The herniation of the upper rear vaginal wall where a small bowel portion bulges into the vagina. Standing leads to a pulling sensation and backache and is relieved when you lie down.
    
    
  • Rectocele: The herniation of the lower rear vaginal wall where the rectum bulges into the vagina. This makes bowel movements difficult to the point that you may need to push on the inside of your vagina to empty your bowel.
    
    

  Prolapsed Uterus Causes

  The following conditions can cause a prolapsed uterus :
  
  
• Pregnancy/multiple childbirths with normal delivery through the vagina
  
  
• Weakness in the pelvic muscles with advancing age
  
  
• Weakening and loss of tissue tone after menopause and loss of natural estrogen
  
  
• Conditions leading to increased pressure in the abdomen such as chronic cough (with bronchitis and asthma), straining (with constipation), pelvic tumors (rare), or an accumulation of fluid in the abdomen
  
  
• Being overweight or obese and its additional strain on pelvic muscles
  
  
• Radical surgery in the pelvic area leading to loss of external support
  

Other risk factors

• Excess weight lifting
  
  
• Caucasian women more commonly affected; African Americans and Asians affected less often

Prolapsed Uterus Symptoms

• A feeling of fullness or pressure in your pelvis (you may describe it as a feeling of sitting on a small ball)
  
  
• Low back pain
  
  
• Feeling that something is coming out of your vagina
  
  
• Painful sexual intercourse
  
  
• Difficulty with urination or moving your bowels
  
  
• Difficulty walking

When to Seek Medical Care

Notify your health care provider if you experience any of the following symptoms :

• You feel the cervix near the opening of the vaginal canal. Or you suffer persistent discomfort from urinary dribbling or the urge to have a bowel movement (rectal urgency).
  
  
• You may not feel the cervix but just pressure in your vaginal canal and the feeling of something coming out of your vagina.
  
  
• You have continuing low back pain with difficulty in walking, urination, and defecation.

Seek medical care immediately if you experience the following :

• Obstruction or difficulty in urination and/or defecation
  
  
• Complete uterine prolapse (your uterus comes out of your vagina)

Exams and Tests

Your health care provider can diagnose uterine prolapse with a medical history and physical examination of the pelvis.

• The doctor may need to examine you in standing position as well as while you are lying down and ask you to cough or strain to increase the pressure in your abdomen.
  
  
• Specific conditions, such as ureteral obstruction due to complete prolapse, may need an intravenous pyelogram (IVP) or renal sonography. Dye is injected into your vein, and a series of x-rays are taken to view its progress through your bladder.
  
  
• Ultrasound may be used to rule out other pelvic problems. In this test, a wand is passed over your abdomen or inserted into your vagina to create images with sound waves.

Prolapsed Uterus Treatment

Treatment depends on how weak the supporting structures around your uterus havebecome.

Prevention

• Reduce your weight.
  
  
• Avoid constipation by eating a high-fiber diet.
  
  
• Do Kegel exercises to strengthen your pelvic muscles.
  
  
• Avoid heavy lifting or straining.

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[Alternative explanation by Medline Plus]

Uterine prolapse is falling or sliding of the uterus from its normal position in the pelvic cavity into the vaginal canal.

Causes

The uterus is held in position in the pelvis by muscles, special ligaments, and other tissue,. The uterus drops into the vaginal canal (prolapses) when these muscles and connective tissues weaken.

Uterine prolapse usually happens in women who have had one or more vaginal births. Normal aging and lack of estrogen hormone after menopause may also cause uterine prolapse, Chronic cough and obesity increase the pressure on the pelvic floor and may contribute to the prolapse.. Uterine prolapse can also be caused by a pelvic tumor, although this is rare.

Chronic constipation and the pushing associated with it can worsen uterine prolapse.

Symptoms

• A feeling as if sitting on a small ball
• Difficult or painful sexual intercourse
• Frequent urination or a sudden, urgent need to empty the bladder
• Low backache
• Pain during intercouse
• Protruding of the uterus and cervix through the vaginal opening
• Repeated bladder infections
• Sensation of heaviness or pulling in the pelvis
• Vaginal bleeding or increased vaginal discharge

Many of the symptoms are worse when standing or sitting for long periods of time.

Exams and Tests

A pelvic examination performed while the woman is bearing down (as if trying to push out a baby) will show how far the uterus comes down.

• Uterine prolapse is mild when the cervixcervix drops into the lower part of the vaginavagina.
• Uterine prolapse is moderate when the cervix drops out of the vaginal opening.

The pelvic exam may reveal that the bladder, front wall of the vagina (cystocelecystocele), or rectum and back wall of the vagina (rectocele) are entering the vaginal area. The urethra and bladder may also be positioned lower in the pelvis than usual.
A mass may be noted on pelvic exam if a tumortumor is causing the prolapse (this is rare).

Treatment

Treatment is not necessary unless the symptoms are bothersome. Most women seek treatment by the time the uterus drops to the opening of the vagina.

Uterine prolapse can be treated with a vaginal pessary or surgery.


VAGINAL PESSARY

A vaginal pessary is a rubber or plastic donut-shaped device that is inserted into the vagina to hold the uterus in place. It may be a temporary or permanent form of treatment. Vaginal pessaries are fitted for each individual woman. Some pessaries are similar to a diaphragm device used for birth control. Many women can be taught how to insert, clean, and remove the pessary herself.

Pessaries may cause an irritating and abnormal smelling discharge, and they require periodic cleaning, sometimes done by the doctor or nurse. In some women, the pessary may rub on and irritate the vaginal wall ( mucosa)mucosa), and in some cases may damage the vagina. Some pessaries may interfere with normal sexual intercourse by limiting the depth of penetration.

LIFESTYLE CHANGES

Weight loss is recommended in women with uterine prolapse who are obese.
Heavy lifting or straining should be avoided, because they can worsen symptoms.
Coughing can also make symptoms worse. Measures to treat and prevent chronic cough should be tried. If the cough is due to smoking, smoking cessation techniques are recommended.

SURGERY

Surgery should not be done until the prolapse symptoms are worse than the risks of having surgery. The specific type of surgery depends on :

• Degree of prolapse
• Desire for future pregnancies
• Other medical conditions
• The women's desire to retain vaginal function
• The woman's age and general health

There are some surgical procedures that can be done without removing the uterus, such as a sacrospinous fixation . This procedure involves using nearby ligaments to support the uterus. Other procedures are available.

Often, a vaginal hysterectomyvaginal hysterectomy is used to correct uterine prolapse. Any sagging of the vaginal walls, urethra, bladder, or rectum can be surgically corrected at the same time.

Outlook (Prognosis)

Most women with mild uterine prolapse do not have bothersome symptoms and don't need treatment.
Vaginal pessaries can be effective for many women with uterine prolapse.
Surgery usually provides excellent results, however, some women may require treatment again in the future.

Possible Complications

Ulceration and infection of the cervix and vaginal walls may occur in severe cases of uterine prolapse.
Urinary tract infectionsUrinary tract infections and other urinary symptoms may occur because of a cystocele. ConstipationConstipation and hemorrhoidshemorrhoids may occur because of a rectocele.

When to Contact a Medical Professional

Call for an appointment with your health care provider if you have symptoms of uterine prolapse.

Prevention

Tightening the pelvic floor muscles using Kegel exercisesKegel exercises helps to strengthen the muscles and reduces the risk of uterine prolapse.

Estrogen therapy, either vaginal or oral, in postmenopausal women may help maintain connective tissue and muscle tone.