Worried about Uterine Prolapse? Let's talk about it simply

Do you sometimes feel a heaviness or pressure in your lower abdomen, especially in the vagina? Do you also feel like something is coming down inside, or like a ball is stuck? This is actually a condition that many women experience, especially after having children and as they get older, but it is a bit embarrassing to talk about in society. We call this Uterine Prolapse. So don't be afraid or embarrassed. Today we will talk about this very simply, in a way that you can understand.

Simply put, what is a prolapsed uterus?

Imagine that your pelvis is made up of a net that holds your important organs, such as your uterus, bladder, and rectum, in place. This strong net is called the pelvic floor muscles and ligaments.

But due to various reasons, especially childbirth and aging, these muscles and ligaments gradually weaken and stretch. Then the support that the uterus that used to be held above it is no longer enough, and it gradually starts to sink down, that is, into the vagina, with gravity. This is what we call a prolapsed uterus.

The severity of this can vary from person to person. For some, the uterus may only be slightly prolapsed, but in severe cases, the uterus may completely protrude from the vagina.

What are the stages of uterine prolapse?

Your doctor may use a classification to determine the extent of this condition. Let's look at it this way to make it easier for you to understand.

Who is most likely to develop this condition? What are the causes?

Although any woman can develop a prolapsed uterus, some are at a higher risk. Let's take a look at the main causes.

• Having children: This risk is higher, especially for women who have had more than one child through vaginal delivery . If the baby weighs more than 4 kilograms (9 pounds), which is a large baby, the damage to the pelvic muscles is greater.
• Menopause: Menopause is the time when your monthly periods stop. During this time, the body's production of the hormone estrogen decreases. This hormone estrogen is what helps keep the muscles in our body, including the pelvic muscles, strong. So when estrogen levels decrease, the muscles weaken and the uterus becomes more likely to prolapse.
• Aging: As we age, the body's muscle strength naturally decreases. This is also common with the pelvic floor muscles.
• Obesity: As body weight increases, the extra weight puts constant pressure on the pelvic muscles, which can weaken them.
• Chronic cough: When you cough hard and continuously due to a medical condition like asthma, each time you cough, it puts pressure on your lower abdomen. This is also a cause of muscle weakness.
• Chronic Constipation: Frequent straining to defecate puts a lot of pressure on the pelvic muscles.
• Heavy lifting: Frequent lifting of heavy objects like buckets and gas cylinders, as well as improper lifting, can also affect this.
• Previous surgery: Muscle weakness can also occur due to previous surgery in the pelvic area.
• Hereditary causes: If your mother or grandmother had this condition, you may be at risk.

What symptoms might you experience?

If your uterus is only slightly prolapsed, you may not notice any symptoms. But as your uterus gradually descends, it starts to press on the surrounding organs, such as the bladder and rectum. That's when these symptoms appear.

These symptoms can usually be worse when you stand for a long time, walk, cough, or sneeze, because gravity puts more pressure on the pelvic muscles.

Is it just the uterus that goes down?

No. When the pelvic floor muscles we talked about earlier weaken, not only the uterus but also other nearby organs can prolapse.

• Cystocele: The bladder descends into the vagina.
• Rectocele: Protrusion of the rectum into the vagina.
• Enterocele: A protrusion of part of the small intestine into the vagina.

How does a doctor find this?

When you go to see a doctor, he or she will ask you about your symptoms. Then, they will do a pelvic examination. The doctor will use a speculum to examine your vagina and uterus. To see how far down your uterus is, you may be asked to cough or do abdominal exercises. This will give you a good idea of ​​how weak your muscles are.

What are the treatments for this?

The best thing is that there are effective treatments for this. Your doctor will decide on the most suitable treatment for you based on the severity of your condition, your age, your general health, and whether you plan to have children in the future.

Treatment can be divided into two main parts.

1. Nonsurgical Options

• Exercise: The best and simplest thing for this is Kegel exercises . This strengthens your pelvic floor muscles. For someone with a slightly prolapsed uterus, even just these exercises can help.
• How to do it? Just as if you were trying to stop the urge to urinate, tighten the muscles around your vagina and anus. Hold for 5-10 seconds, then relax completely. Repeat this about 10 times in a row. It's best if you can do this three or four times a day. You can do this while sitting, standing, or at any time.
• Vaginal Pessary: ​​This is a ring or doughnut-shaped device made of rubber or plastic. Your doctor will choose the right size for you and insert it into your vagina to support your uterus. It should be cleaned regularly and removed before sex.
• Lifestyle changes:
• Weight control: Controlling your weight can reduce the pressure on your pelvic muscles.
• Diet: If you have constipation, add fiber-rich vegetables, fruits, and greens to your diet. Drink plenty of water throughout the day. This can help reduce bloating.

2. Surgical Options

If the condition is severe or other treatments have not been successful, your doctor may recommend surgery.

• Hysterectomy: The main surgery for a low-lying uterus is to completely remove the uterus. This can be done through the vagina or through an incision in the abdomen. However, this is a major surgery. After this surgery, you will not be able to have children again. Therefore, if you are planning to have children in the future, you should discuss this with your doctor.
• Uterine suspension: This involves moving the prolapsed uterus back into its original position and attaching it to the surrounding strong ligaments or using something like an artificial mesh.

What can we do to reduce this risk?

Some things, like having children and aging, we can't control. But there are many things we can do to reduce the risk of these conditions.

• Do Kegel exercises regularly. It is best to start doing this during pregnancy.
• Maintain a healthy weight.
• Avoid constipation. Drink plenty of water and eat foods high in fiber.
• Avoid smoking. Chronic cough caused by smoking is harmful to the pelvic muscles.
• Follow the correct technique when lifting weights. Keep your back straight and bend your knees when lifting weights. Do not pull at once.

Uterine Prolapse, Women's Health, Pelvic Floor Muscles, Hysterectomy, Kegel exercises, Menopause, Sri Lanka