Uterine prolapse is falling or sliding of the uterus from its normal position in the pelvic cavity into the vaginal canal.
The uterus is held in position by adequate ligaments. Besides, it has the support of the muscular structures of vagina and all other local tissues and muscles. Due to laxity of support by muscles, tissues and ligaments, the uterus sags downwards.
Prolapse of the uterus may be one of three types, depending on severity:
First-degree prolapse occurs when the uterus sags downward into the upper vagina.
Second-degree prolapse occurs when the cervix is at or near the vagina.
Third-degree prolapse occurs when the cervix is outside the vagina.
Fourth- degree prolapse occurs when the entire uterus is outside the vagina.
Pregnancy and trauma incurred during childbirth, particularly with large babies or after a difficult labor and delivery, are the main causes of muscle weakness and stretching of supporting tissues leading to uterine prolapse. Loss of muscle tone associated with aging and reduced amounts of circulating estrogen after menopause also may contribute to uterine prolapse. In rare circumstances, uterine prolapse may be caused by a tumor in the pelvic cavity.
Genetics also may play a role in strength of supporting tissues. Women of Northern European descent have a higher incidence of uterine prolapse than do women of Asian and African descent.
Certain factors may increase your risk of uterine prolapse:
One or more pregnancies and vaginal births
Giving birth to a large baby
Frequent heavy lifting
Frequent straining during bowel movements
Genetic predisposition to weakness in connective tissue
Some conditions, such as obesity, chronic constipation and chronic obstructive pulmonary disorder (COPD), can place a strain on the muscles and connective tissue in your pelvis and may play a role in the development of uterine prolapse.
The major symptoms may be a feeling of heaviness, fullness or "falling out" in the vaginal area. The patient may also complain of backache or inability to control urination.
In some cases where the cervix and uterus are low in the vaginal canal, the cervix may be seen protruding, giving the patient the impression that a tumor is bulging out of her vagina.
It is not uncommon for the cervix or vaginal epithelium to become damaged or ulcerated, in which case the patient may report pain or vaginal bleeding.
There is often discharge from the cervix and vagina when secondary infection occurs. Patients may also complain of difficulty walking comfortably.
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 cervix drops into the lower part of the vagina.
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 (cystocele), 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.
Ultrasound to rule out other pelvic diseases.
A mass may be noted on pelvic exam if a tumor is causing the prolapse (this is rare).
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.
Losing weight, stopping smoking and getting proper treatment for contributing medical problems, such as lung disease with coughing, may slow the progression of uterine prolapse.
Uterine prolapse can be treated with a vaginal pessary or surgery.
It is easier to prevent prolapse of uterus than cure it after its occurrence. The measures to prevent it should include good antenatal care in pregnancy, proper management
and timely intervention during delivery, good postnatal care with proper rest, correct diet and appropriate exercise so as to strengthen the pelvic musculature.
Homoeopathy shows good results in treating uterine prolapse upto stage 3. These medicines will help in developing strength in the supports of the uterus.
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