Hormone replacement, Women's Health, Infant and Children | March 29, 2016 | Author: The Super Pharmacist
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.
Since 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.
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.
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).
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.
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.
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.
The initial, conservative treatment for uterine prolapse may include:
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 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.
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