Free Shipping on orders over $99

Prolapsed Uterus: Discussions of causes, symptoms and appropriate treatment

Hormone replacement, Women's Health, Infant and Children | March 29, 2016 | Author: The Super Pharmacist

women, hormone replacement, infant, hrt

Prolapsed Uterus: Discussions of causes, symptoms and appropriate treatment

A prolapsed uterus is a uterus that has extended down into the vagina. This condition decreases the size of the vagina itself, because it has been invaded by the overlying uterus. Indeed, the uterus may extend through the opening of the vagina and protrude outside the body.

Symptoms of a prolapsed uterus

Vaginal bulging

Symptoms of a prolapsed uterusSince the uterus has moved beyond its normal location within the lower abdomen and pelvis, it may press on the vagina and surrounding structures.

Thus, most symptoms of prolapsed uterus are related to this abnormal positioning.

Almost all women with prolapsed uterus will experience increased vaginal pressure or sense of fullness within the vagina. This sensation is sometimes referred to as vaginal bulging.

Urinary symptoms

The uterus may press on the urinary bladder, causing a sensation of the need to urinate frequently or urgently. Indeed, the uterus may press on the bladder to the point such that the effective size of the bladder is reduced. Consequently, women with prolapsed uterus may need to urinate more frequently, but the total volume of urine is less than normal. 

Prolapsed uterus is a cause of overactive bladder, which causes urgency (the sudden need to urinate), frequency (frequent urination), and incontinence (loss of bladder control). At the same time, the prolapsed uterus may interfere with the woman's ability to urinate.

Bowel symptoms

If the uterus extends backwards, it may press on the rectum and anus. The most common gastrointestinal complaint in women with a prolapsed uterus is constipation. Other symptoms include faecal urgency (the sudden need to have a bowel motion), fecal incontinence (loss of bowel control), and incomplete emptying (the rectum retains faeces despite having a bowel movement).

Sexual dysfunction

Sadly, some women may experience uncontrollable urination or defecation during sexual intercourse because of a prolapsed uterus. This often leads women to avoid sexual activity entirely, due to the potential embarrassment of this occurrence. Indeed, uterine prolapse can negatively impact a woman's body image and sexuality.

Symptoms of a prolapsed uterusCauses of prolapsed uterus

The uterus is the female organ that holds and nourishes a fetus during pregnancy.

The uterus is held in position by various muscles and ligaments within the pelvis and abdomen. These suspensory muscles and ligaments tend to weaken and loosen with time and after certain events.

If these structures become too lax, gravity pulls the uterus lower in the pelvis, beyond the capacity of the muscles and ligaments to hold it in place.

Risk factors for uterine prolapse

Several factors have been identified that increase the likelihood that a woman will experience a prolapsed uterus at some point in her life.

Carrying a fetus to term increases the risk of uterine prolapse significantly, and this risk increases with each additional pregnancy. In fact, the first pregnancy increases the risk of future prolapse by 4 times in the second pregnancy increases the risk eightfold. A woman who has had four full-term pregnancies has a 10-fold greater risk of having a prolapsed uterus than a woman who was never pregnant. Importantly, these estimated risks are for women who have undergone vaginal delivery as opposed to cesarean section. 

Older women are at greater risk for prolapsed uterus than younger women are. This is likely due to changes that occur during aging that contribute to muscle and ligament laxity.

Overweight woman. For reasons that are not entirely clear, women who are overweight and obese, i.e. women who have a body mass index greater than or equal to 25, are twice as likely to have uterine prolapse as normal weight women are. Unfortunately, overweight and obese women who lose weight appear to still be at increased risk of uterine prolapse. 

Compared to pregnancy, age, and weight, other risk factors for uterine prolapse are comparatively minor.

Hysterectomy. Women who have had a hysterectomy may be at increased risk for uterine prolapse. 

Chronic constipation and occupations that require heavy lifting may or may not increase the risk of prolapsed uterus. 

Genetics. The condition appears to have some genetic component, since women with a family history of uterine prolapse are 2.5 times as likely to develop a prolapsed uterus as those who have no family history of the condition. 

Connective tissue disorders such as Ehlers-Danlos syndrome or Marfan syndrome also appear to increase the risk of uterine prolapse.

Treatment of uterine prolapse

The initial, conservative treatment for uterine prolapse may include: 

  • the use of a supportive pessary
  • pelvic floor muscle (Kegel) exercises
  • oestrogen therapy. 

A pessary is a medical device that is placed within the vagina that provides additional support for the uterus and, ideally, holds it in its proper place. Not all women tolerate the use of a pessary, especially those who are younger and have never been pregnant. 

The efficacy of oestrogen therapy and pelvic floor muscle exercises is questionable, though some patients may benefit for one or both of these therapies. Considering their relative safety, these options are normally recommended to assess its benefits for the individual.

Surgery

Treatment of uterine prolapseSurgery may be required if conservative measures fail. Numerous surgical procedures have been used to treat uterine prolapse. The two main types are reconstructive and obliterative. The reconstructive approach attempts to correct and restore the normal anatomy while the obliterative approach (e.g. colpocleisis) alters the anatomy of the top portion of the vagina to hold the uterus in place. 

Either of these procedures may or may not be combined with a hysterectomy, which is the surgical removal of the uterus.

The surgical management of prolapsed uterus is complex; deciding on the appropriate surgical approach requires thorough discussion with a gynecologic surgeon. Factors that should be considered include age, desire for children, extent of the condition, general health of the person including existing conditions among others.

www.superpharmacy.com.au  Australia’s best online discount chemist

References

Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. Lancet. Mar 24 2007;369(9566):1027-1038. doi:10.1016/s0140-6736(07)60462-0

Tan JS, Lukacz ES, Menefee SA, Powell CR, Nager CW. Predictive value of prolapse symptoms: a large database study. Int Urogynecol J Pelvic Floor Dysfunct. May-Jun 2005;16(3):203-209; discussion 209. doi:10.1007/s00192-004-1243-8

Patil A, Duckett JR. Effect of prolapse repair on voiding and bladder overactivity. Curr Opin Obstet Gynecol. Oct 2010;22(5):399-403. doi:10.1097/GCO.0b013e32833e498a

de Boer TA, Salvatore S, Cardozo L, et al. Pelvic organ prolapse and overactive bladder. Neurourol Urodyn. 2010;29(1):30-39. doi:10.1002/nau.20858

Weber AM, Walters MD, Ballard LA, Booher DL, Piedmonte MR. Posterior vaginal prolapse and bowel function. Am J Obstet Gynecol. Dec 1998;179(6 Pt 1):1446-1449; discussion 1449-1450.

Ellerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler K, Bent AE. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol. Dec 2001;185(6):1332-1337; discussion 1337-1338. doi:10.1067/mob.2001.119078

Barber MD, Visco AG, Wyman JF, Fantl JA, Bump RC. Sexual function in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol. Feb 2002;99(2):281-289.

Novi JM, Jeronis S, Morgan MA, Arya LA. Sexual function in women with pelvic organ prolapse compared to women without pelvic organ prolapse. J Urol. May 2005;173(5):1669-1672. doi:10.1097/01.ju.0000154618.40300.c8

Lowder JL, Ghetti C, Nikolajski C, Oliphant SS, Zyczynski HM. Body image perceptions in women with pelvic organ prolapse: a qualitative study. Am J Obstet Gynecol. May 2011;204(5):441 e441-445. doi:10.1016/j.ajog.2010.12.024

Barber MD. Contemporary views on female pelvic anatomy. Cleve Clin J Med. Dec 2005;72 Suppl 4:S3-11.

Patel DA, Xu X, Thomason AD, Ransom SB, Ivy JS, DeLancey JO. Childbirth and pelvic floor dysfunction: an epidemiologic approach to the assessment of prevention opportunities at delivery. Am J Obstet Gynecol. Jul 2006;195(1):23-28. doi:10.1016/j.ajog.2006.01.042

Mant J, Painter R, Vessey M. Epidemiology of genital prolapse: observations from the Oxford Family Planning Association Study. Br J Obstet Gynaecol. May 1997;104(5):579-585.

Swift S, Woodman P, O'Boyle A, et al. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol. Mar 2005;192(3):795-806. doi:10.1016/j.ajog.2004.10.602

Tinelli A, Malvasi A, Rahimi S, et al. Age-related pelvic floor modifications and prolapse risk factors in postmenopausal women. Menopause. Jan-Feb 2010;17(1):204-212. doi:10.1097/gme.0b013e3181b0c2ae

Kudish BI, Iglesia CB, Sokol RJ, et al. Effect of weight change on natural history of pelvic organ prolapse. Obstet Gynecol. Jan 2009;113(1):81-88. doi:10.1097/AOG.0b013e318190a0dd

Spilsbury K, Hammond I, Bulsara M, Semmens JB. Morbidity outcomes of 78,577 hysterectomies for benign reasons over 23 years. BJOG. Nov 2008;115(12):1473-1483. doi:10.1111/j.1471-0528.2008.01921.x

Lince SL, van Kempen LC, Vierhout ME, Kluivers KB. A systematic review of clinical studies on hereditary factors in pelvic organ prolapse. Int Urogynecol J. Oct 2012;23(10):1327-1336. doi:10.1007/s00192-012-1704-4

Carley ME, Schaffer J. Urinary incontinence and pelvic organ prolapse in women with Marfan or Ehlers Danlos syndrome. Am J Obstet Gynecol. May 2000;182(5):1021-1023.

Culligan PJ. Nonsurgical management of pelvic organ prolapse. Obstet Gynecol. Apr 2012;119(4):852-860. doi:10.1097/AOG.0b013e31824c0806

Pott-Grinstein E, Newcomer JR. Gynecologists' patterns of prescribing pessaries. J Reprod Med. Mar 2001;46(3):205-208.

Kapoor DS, Thakar R, Sultan AH, Oliver R. Conservative versus surgical management of prolapse: what dictates patient choice? Int Urogynecol J Pelvic Floor Dysfunct. Oct 2009;20(10):1157-1161. doi:10.1007/s00192-009-0930-x

Braekken IH, Majida M, Engh ME, Bo K. Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. Am J Obstet Gynecol. Aug 2010;203(2):170 e171-177. doi:10.1016/j.ajog.2010.02.037

Ismail SI, Bain C, Hagen S. Oestrogens for treatment or prevention of pelvic organ prolapse in postmenopausal women. Cochrane Database Syst Rev. 2010(9):CD007063. doi:10.1002/14651858.CD007063.pub2

Maher C, Baessler K, Glazener CM, Adams EJ, Hagen S. Surgical management of pelvic organ prolapse in women: a short version Cochrane review. Neurourol Urodyn. 2008;27(1):3-12. doi:10.1002/nau.20542

Abbasy S, Kenton K. Obliterative procedures for pelvic organ prolapse. Clin Obstet Gynecol. Mar 2010;53(1):86-98. doi:10.1097/GRF.0b013e3181cd4252

Denehy TR, Choe JY, Gregori CA, Breen JL. Modified Le Fort partial colpocleisis with Kelly urethral plication and posterior colpoperineoplasty in the medically compromised elderly: a comparison with vaginal hysterectomy, anterior colporrhaphy, and posterior colpoperineoplasty. Am J Obstet Gynecol. Dec 1995;173(6):1697-1701; discussion 1701-1692.

backBack to Blog Home