UTERINE PROLAPSE

Pelvic organ prolapse is bulging of one or more of the pelvic organs into the vagina.These organs are the uterus, vagina, bowel and bladder.

Pelvic organ prolapse is due to the weakening of the muscles of the pelvic floor, causing the support of the pelvic organs to give way.

The risk of developing pelvic organ prolapse can be increased by:

  • your age
  • childbirth, particularly if you had a long or difficult labour, or gave birth to multiple babies or a large baby
  • changes caused by the menopause – such as weakening of tissue and low levels of the hormone oestrogen
  • being overweight, obese or having large pelvic cysts – which creates extra pressure in the pelvic area
  • previous pelvic surgery – such as a hysterectomy or bladder repair
  • repeated heavy lifting and manual work
  • excessive straining when going to the toilet because of long-termconstipation

Pelvic organ prolapse can affect the front, top or back of the vagina. The main types of prolapse are:

  • anterior prolapse (cystocele) – the bladder bulges into the front wall of the vagina
  • prolapse of the uterus and cervix–which can be the result of previous treatment to remove the womb (hysterectomy)
  • posterior wall prolapse(rectocoele or enterocoele) –when the bowel bulges forward into the back wall of the vagina

Symptoms may include:

  • a sensation of a bulge or something coming down or out of the vagina, which sometimes needs to be pushed back
  • discomfort during sex
  • problems passing urine
    • slow stream
    • a feeling of not emptying the bladder fully
    • needing to urinate more often
    • leaking a small amount of urine when you cough, sneeze or exercise (stress incontinence)

DIAGNOSIS

  • History and Physical Examination
    • Internal Pelvic Examinationn
      • They’ll ask you to undress from the waist down and lie back on the examination bed, while they feel for any lumps in your pelvic area.
    • Further tests
    • Urodynamics
      • A catheter will be inserted to assess bladder function and leakage problems

 

RECOMMENDED MEDICATIONS

Many women with prolapse don’t need treatment, as the problem doesn’t seriously interfere with their normal activities.

  • weight loss and pelvic floor exercises are usually recommended in mild cases.
  • Vaginal Pessary- a ring-like structure that holds the pelvic organs in place.
  • Surgery- This usually involves giving support to the prolapsed organ. In some cases, complete removal of the womb (hysterectomy) is required, especially if the womb has prolapsed out.

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