UTERINE PROLAPSE

WHAT WOMEN SHOULD KNOW?

By Team TDO

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Sonal is a 36-year-old active female. She has 2 daughters, elder one is 3 years old and the younger one is one year old. After the birth of her second daughter, she noticed something coming out of her vagina and not being able to hold urine. She was unable to exercise or walk for long without the appearance of these symptoms. This is when she decided to consult her gynaecologist. It was only when the gynaecologist examined her, she came to know that she had a uterine prolapse. She was told by her doctor that since she came early, this problem could be treated without surgery. Now Sonal can do all her activities without any discomfort.

What woman should know?

The body of a woman undergoes various changes during different phases of life, such as childbirth or pregnancy. Any woman who has been through this phase knows how challenging these phases can be with a myriad of complications, uterine prolapse being one amongst them. Want to know more about this condition? Read on more to improve your understanding of uterine prolapse.

Uterine prolapse is a common problem. But due to the lack of public awareness & health education, it has been existing as a complicated problem in Nepal. "A 2005 survey found out that more than 6 lakhs people are suffering from uterine prolapse in Nepal, among which, more than 2 lakhs people needed immediate surgery."

Image by Joey Thompson
Image by Joey Thompson

Image by Jonathan Borba
Image by Jonathan Borba

Image by Jonathan Borba
Image by Jonathan Borba

Image by Joey Thompson
Image by Joey Thompson

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So, What is Uterine Prolapse?

The uterus of a woman is supported by various muscles & tissues. When these muscles & tissues weaken, the uterus slips down. The slippage of the whole uterus or some part of it or protruding out of the vagina is called uterine prolapse.

The problem of uterine prolapse is witnessed more in a postmenopausal woman. But this can occur in women of any age. It can be seen in any woman who is an adult from the prospect of reproduction. We can estimate that this number has grown further at present. But many women are now aware of this disease. However, due to shame and fear, very few women seek medical help.

Symptoms
Now that we know what is uterine prolapse, let's understand what its indications are. Although mild uterine prolapse doesn't show any remarkable symptoms, moderate to the severe condition may have the following

Symptoms:

  • Pain or sense of heaviness in the pelvis.

  • Tissues protruding out from the vagina.

  • Trouble in passing out urine and stool.

  • Unable to hold urine.

  • Feeling as if you are sitting on a rounded object or a small ball.

  • Feeling as if something is going to come out from the vagina.
     

Causes:
Let's now understand what can cause this problem. The main cause of uterine prolapse is the weakening of supportive muscles and tissues. Some of the causes of weakened muscles and tissues are:

  1. Pregnancy

  2. Complication during delivery

  3. Delivering a large baby

  4. Obesity

  5. after menopauseLowering of estrogen hormones

  6. the digestive processChronic constipation or issues with

  7. coughBronchitis or problem of chronic

  8. Difficult work or heavy lifting.

Besides these, there are also other factors that can increase the risk of uterine prolapse. Though they do not play a direct role in causing uterine prolapse, some indirect factors that can increase the risk of weakened muscles are:

  1. More than one vaginal birth without surgery

  2. Increasing age

  3. Excessive fats in the body

  4. Pelvic surgery

  5. Hereditary history of weak tissue

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Prevention
Although menopause and other conditions causing uterine prolapsed are inevitable, uterine prolapse is not. The good news is certain precautionary measures can aid in preventing uterine prolapse. Some of them are:

 

  1. Kegel Exercises: Kegal's or Kegal exercise is a workout to strengthen your muscles around your waist & buttock. This can be done as per your convenience in the morning, afternoon or at night and strengthens the area where your reproductive organs including vagina and uterus are located. This exercise is not only fruitful for uterine prolapse but also for other conditions.

  2. Prevent constipation Constipation causes the stress on the muscles around the uterus and increases the risk of uterine prolapse. So, drink plenty of water and fluids and eat fruits, beans etc.

  3. Avoid heavy lifting work Heavy work and heavy lifting for a continuous period of time may cause stress on the waist. As a result, muscles in that part of the body are strained and this might lead to uterine prolapse. Avoid heavy lifting if possible and use your legs instead of your waist or back when lifting.

  4. Maintain a healthy weight Additional weight in the abdominal area puts pressure on the pelvic floor, increasing the risk of uterine prolapse. Maintaining a healthy weight prevents this stress and thus lower the risk of uterine prolapse.

Treatment
Treatment is not required in all cases of uterine prolapse. Your doctor will advise treatment or precautionary measures depending on your condition. If treatment is required, the type of treatment depends on the severity of uterine prolapse. Non-surgical forms of treatment options include precautionary measures and/or pessary.


Pessary
A pessary is a device inserted into the vagina to prevent the slippage of the uterus and other organs located at the waist. A pessary can be used with advice from your gynaecologist depending on which stage you are in. Ring Pessary, Gehrung Pessary, Gellhorn Pessary and Cube Pessary are four types of Pessary.
Ring Pessary is a widely used type of Pessary for uterine prolapse. But as medical assistance for uterine prolapse is usually sought at the last stage in Nepal, pessary rarely comes into play.

 

Surgery
Surgery involves the removal of the uterus or placing the uterus in its position using surgical materials. In cases where the uterus is removed, the mensuration cycle will stop after the surgery. As the uterus is removed during surgery, a woman cannot be pregnant again. So, those women who are planning for their next baby should not seek surgery.

The Problem of Uterine Prolapse in Nepal

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According to the report published in the International Journal of Women's Health, Surgery is done in Nepal at any stage of Uterine Prolapse. Early marriage in the rural areas of Nepal and child delivery at an early age accounts for the increasing problem of Uterine Prolapse.


People go on continuously delivering babies without using the methods of family planning and this has also contributed into this problem. Such practices are found particularly in rural areas.

Lack of proper care from the family and society at the time of pregnancy and after child-birth. Childbirth also increases the weakness in women. The problem of uterine prolapse can be minimized by eating nutritious food, taking proper rest, avoiding heavy lifting and by not giving birth to many children. It is recommended to consult your doctor in case you have any symptoms of uterine prolapse or in cases of doubts.