UTERO VAGINAL PROLAPSE
Popelo ya go wa ( Falling uterus)
Uterine prolapse results from the relaxation or weakening of the Pelvic floor and it supports ie the weakening of the supportive muscles and ligaments of the pelvic floor. This condition, which affects women and is usually caused by childbirth, aging, and problems with support, causes the pelvic floor to sag and press into the wall of the vagina.
How does this happen?
The pelvic floor normally holds the uterus and the bladder in position above the vagina. The uterus is normally held in place by the pelvic muscles and supporting ligaments. When these muscles become weakened or injured, uterine prolapse can occur. In mild cases, a portion of the uterus descends into the top of the vagina. In more serious cases, the uterus may even protrude through the vaginal opening and outside the vagina. A prolapse can be associated with or accompanied by a urethrocoele and cystocoele (urethra and/or bladder bulge along the front wall of the vagina) and rectocoele (rectal wall bulges into the back wall of the vagina).
1st degree,2nd & 3rd Degree uterine prolapse
Symptoms
· A lump in front or back of the vagina, or a lump that projects outside of the vagina.
· Abdominal discomfort or a feeling of heaviness.
· Vague discomfort or pressure in the pelvic region/vagina.
· Backache that worsens with lifting.
· Frequent and painful urination.
· Occasional stress incontinence (urine leakage when laughing, coughing, or sneezing).
· Difficulty in moving bowels.
· Pain with sexual intercourse.
· Excessive menstrual bleeding or abnormal vaginal discharge or bleeding.
Causes
Prolapse occurs when muscles and ligaments at the base of the pelvis become extremely stretched, usually as a result of childbirth or aging. Women who have borne several children and/or who have gone through difficult and prolonged labour are more prone to prolapse.
Other factors that can increase the likelihood of uterine prolapse include: Obesity, uterine cancer, diabetes, chronic bronchitis, asthma, heavy lifting or straining (particularly if the pelvic muscles are already weakened), Two-thirds of all women who prolapse, do so before the age of 55 years.
People at risk
• People who are obese
• Repeated childbirth, although one pregnancy and vaginal delivery can weaken the area enough to eventually lead to prolapse, especially if the birth was traumatic (prolonged intense pushing stage and not allowing tissues to stretch gradually, episiotomy, forceps, vacuum extraction. (No, a caesarean delivery will NOT prevent a prolapse at a later date! but will reduce the chance of happening)
• Advancing age (ie gravity at work).
• Conditions that cause increased intra-abdominal pressure such as tumors, chronic coughing, chronic constipation.
• Poor physical fitness.
Occupations requiring heavy lifting
Preventive measures
· Maintain appropriate weight.
· Practise pelvic-strengthening exercises during pregnancy and after childbirth (Kegel exercises). Kegel exercises can tone the pelvic and vaginal muscles when prolapse is beginning and may prevent the condition from getting worse. These exercises can be done in two ways:
Tighten and squeeze the vagina and rectum by drawing the muscles inward and upward. Hold this position for five to ten seconds, then relax. Repeat as many times as possible, preferably at least 100 times a day
o When urinating, start and stop the flow of urine as many times as possible. This form of the exercise is particularly useful for stress incontinence as well
• Engage in a regular exercise program to maintain good muscle strength.
• Eat a normal, well-balanced diet.
Avoid constipation by following a balanced diet with enough roughage
Problems arising from utero vaginal prolapse
Aggressive treatment is not always necessary because prolapse is not a health risk. Exercise can often improve muscle function. Severe prolapse can be cured with surgery.
Problems created by prolapse
• Ulceration of the cervix caused by the friction from the movement of the cervix
• Increased risk of infection or injury to pelvic organs.
• Urinary tract obstruction.
• A patient with uterine prolapse may have lower back or sacral pain while standing, although many patients are asymptomatic.
• A patient with procidentia (A sinking or prolapse of an organ or part) may experience lower back pain, sacral pain, discomfort when walking (secondary to the protruding "mass"), and bleeding (secondary to ulceration of the cervix and vaginal mucosa).
• A patient with total vaginal vault prolapse may experience pain, especially when sitting. Third-degree uterine prolapse or total vaginal vault prolapse may lead to ulceration of the vaginal mucosa and bladder or rectal dysfunction (eg, difficulty voiding, chronic residual urine) that is often worse after prolonged standing and is presumably due to urethral kinking, and at least two thirds develop stress incontinence when the prolapse is reduced. In some patients, urethral kinking is protective, because it stops urine from leaking when the anterior vagina and bladder protrude.
Consult a Guynaecologist specially trained to do prolapse surgery for the management of prolapse
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