- What is a uterine prolapse?
- What is Uterine Suspension?
- Causes of uterine prolapse
- Symptoms of uterine prolapse
- Who are at risk?
- Complications of uterine prolapse
- The procedure
- Risks and Complications of a Uterine Suspension
- Prevention of Uterine Prolapse
- How long does a uterine suspension last?
- Are Kegels exercises useful for a prolapsed uterus?
- Why is it important to have the surgery premenopausal? Will it stand a better chance of withstanding menopause later on?
- Have you yourself seen any successful suspension cases that lasted for a long time? If so, what kind of surgery was it and how long have they lasted so far.
- Does wearing a pessary slow down the progression of uterine prolapse until a woman can schedule surgery? If a woman can keep a pessary in does this suggest that surgery might also be more of a success?
- Is there any non-surgical method of treating a prolapsed uterus?
What is uterine prolapse?
Uterine prolapse is a condition in which a woman’s uterus (womb) slides down or slips out of its normal position in the pelvic cavity into the vaginal canal. The uterus is usually held in position by pelvic muscles, ligaments, and tissues. The pelvic muscles and the ligaments supporting the uterus may weaken, causing the uterus to descend down the vaginal canal. Damage during childbirth, effects of gravity, estrogen loss, and repeated straining over the years may all contribute to the weakening of the pelvic muscles and ligaments.
What is Uterine Suspension?
Uterine suspension is a procedure that returns the prolapsed uterus to its normal position. It involves reattaching pelvic ligaments and tissues to the uterus to keep it in proper position. A sling may also be used to support the uterus in place. Beverly Hills Medical Group has pioneered vaginal surgery techniques for uterine prolapse that is entirely vaginal in approach with absolutely no skin incisions. Uterine Suspension may be done under general, regional, or local anesthesia in the surgery center or operating room. Uterine Suspension takes more or less 60 minutes to perform.
Causes of uterine prolapse
The uterus is held in place within the pelvis by a group of muscles and ligaments. As these structures weaken, they become unable to hold the uterus in position, causing the uterus to sag. There are several factors that may contribute to the weakening of the pelvic muscles, including:
Loss of muscle tone as the result of aging Multiple childbirths, trauma during delivery Reduced circulating estrogen after menopause Obesity Chronic coughing or straining Chronic constipation.
Symptoms of uterine prolapse
Women with mild cases of uterine prolapse may have no obvious symptoms. However, as the uterus slips further out of position, it can place pressure on other pelvic organs–such as the bladder or bowel–causing a variety of symptoms, including:
A feeling of heaviness or pressure in the pelvis A protrusion of tissue from the opening of the vagina Pain in the pelvis, abdomen or lower back Pain during intercourse Low backache Recurrent bladder infections Unusual or excessive discharge from the vagina Constipation Difficulty with urination, including involuntary loss of urine (incontinence), or urinary frequency or urgency
Symptoms may be worsened by prolonged standing or walking. This is due to the added pressure placed on the pelvic muscles by gravity.
Who are at risk?
Uterine prolapse most often occurs in women who have had more than one baby through normal vaginal delivery and in post-menopausal women. Menopause occurs when a woman’s ovaries stop producing the hormones that regulate her monthly menstrual cycle, and she stops having regular menstrual periods. One of these hormones, estrogen, helps keep the pelvic muscles strong. Reduced amounts of this hormone contribute to the weakening of the pelvic muscles.
The doctor will perform a pelvic examination to determine if the uterus has lowered from its normal position. During a pelvic exam, the doctor inserts a speculum (an instrument that lets the clinician see inside the vagina) and examines the vagina and uterus. The doctor will feel for any bulges caused by the uterus protruding into the vaginal canal.
There are surgical and non-surgical options for treating uterine prolapse. The treatment chosen will depend on the severity of the condition, as well as the woman’s general health, age and desire to have children. It is best recommended to visit us at Beverly Hills Medical Group to assess the best treatment that will fit your needs. Treatment generally is effective for most women. Treatment options include the following:
Exercise — Special exercises, called Kegel exercises, can help strengthen the pelvic floor muscles. To do Kegel exercises, tighten your pelvic muscles as if you are trying to hold back urine. Hold the muscles tight for a few seconds and then release. Repeat 10 times. You may do these exercises anywhere and at any time (up to four times a day)
Vaginal pessary — A pessary is a rubber or plastic doughnut-shaped device that fits around or under the lower part of the uterus (cervix), helping to prop up the uterus and hold it in place. A health care provider will fit and insert the pessary, which must be cleaned frequently and removed before sex. Estrogen replacement therapy (ERT) — Taking estrogen may help to limit further weakness of the muscles and other connective tissues that support the uterus. However, there are some drawbacks to taking estrogen, such as an increased risk of blood clots, gallbladder disease and breast cancer. The decision to use ERT must be made with your doctor after carefully weighing all of the risks and benefits.
Hysterectomy — Uterine prolapse may be treated by removing the uterus in a surgical procedure called hysterectomy. This may be done through an incision made in the vagina (vaginal hysterectomy) or through the abdomen (abdominal hysterectomy). Hysterectomy is major surgery, and removing the uterus means pregnancy is no longer possible. Uterine suspension — This procedure involves putting the uterus back into its normal position. This may be done by reattaching the pelvic ligaments to the lower part of the uterus to hold it in place. Another technique uses a special material that acts like a sling to support the uterus in its proper position. Recent advances include performing this with minimally invasive techniques and laparoscopically (through small band aid sized incisions) that decrease post operative pain and speed recovery.
Complications of uterine prolapse
Left untreated, uterine prolapse can interfere with bowel, bladder and sexual functions. Recurrent bladder infections, urinary incontinence, difficulty in urination, and constipation may still be experienced.
Prevention of Uterine Prolapse
It may not be possible to prevent all cases of uterine prolapse, but there are steps that can be taken to help reduce the risk:
- Maintain a healthy body weight.
- Exercise regularly (for 20 to 30 minutes, three to five times per week), including Kegel exercises, which may be done up to four times a day. Be sure to consult us before starting any new exercise program.
- Eat a healthy diet balanced in protein, fat and carbohydrates. For example, eat at least 5 to 9 servings of fruits and vegetables per day. Also, eat food that is high in dietary fiber (such as whole grain cereals, legumes and vegetables), and minimize your daily fat intake to 25 to 30 grams. Using the Food Guide Pyramid is a good way to help ensure that you are meeting your nutrition needs. A healthy diet can help maintain weight and prevent constipation.
- Stop smoking. This reduces the risk of developing a chronic cough, which can put extra strain on the pelvic muscles.
- Consider estrogen replacement therapy after menopause. Use correct lifting techniques.
Q: How long does a uterine suspension last?
A: There are no studies that show how long exactly a uterine suspension will last. According to a few researches found, 30-40% of patients who have had a uterine suspension for urinary incontinence have had no problems so far since the surgery. Some successful suspensions have lasted for as long as 30 years.
Q: Kegel exercises for prolapse — are they useful? Have you found exercise of the pelvic floor muscle to be of any real value with uterine prolapse?
A: This actually depends on the severity of the prolapsed uterus. For mild cases, the Kegel exercises may prove to be useful, although results may only be observed after at least 6 months of regularly performing the exercise. If the prolapsed uterus is severe, treatment may include the placement of a pessary or uterine suspension.
Q: Why is it important to have the surgery premenopausal? Will it stand a better chance of withstanding menopause later on?
A: The repair seems to heal faster in women who have had the surgery before menopause. It may have something to do with the amount of collagen and estrogen in our body pre-menopausal.
Q: Does wearing a pessary slow down the progression of uterine prolapse until a woman can schedule surgery? If a woman can keep a pessary in does this suggest that surgery might also be more of a success?
A: A pessary can slow down the progression of uterine prolapse while waiting for the surgery schedule. It can likewise help relieve some signs and symptoms associated with the prolapse (e.g. heaviness in vaginal area, pain in the pelvis, and tissue protrusion in the vaginal canal). Although the pessary may temporarily relieve symptoms, it does not suggest success and effectiveness of the surgery.
Q: Is there any non-surgical method of treating a prolapsed uterus?
A: A woman may opt to perform Kegels exercises regularly if only a mild prolapse is involved. A pessary, which is a device inserted in the vagina to support the uterus, may be used as a non-surgical method of treatment. For sever cases, uterine suspension or a hysterectomy may be recommended.