Uterus is a female reproductive system organ. Its shape is like pear( upside down) & is located inside pelvis. Normally various muscles (normally known pelvic floor or levator ani muscles) tissues and ligaments (round ligament, uterosacral ligament, broad ligament, ovarian ligament) held the uterus inside the pelvis. In some women these muscles become weaken because of pregnancy, difficult delivery or childbirth. As women ages, due to natural hormonal loss (estrogen), uterus can drop into vaginal canal causing a condition known as prolapsed uterus.
Muscle weakness allows uterus to sag or come completely out of body in different phases:
- First stage: The cervix drops into vagina
- Second stage: The cervix drops to the level just inside the opening of vagina.
- Third stage: the cervix comes out of vagina.
- Fourth stage: in this stage uterus comes entirely outside the vagina, known as procidentia due to the weakness of all supporting muscles.
- Cystocele: bulging of vaginal wall(upper) where a part of bladder bulges into vagina which may leads to retention, regency, urinary frequency and incontinence (urine loss).
- Retrocele: the herniation of lower rear vaginal wall where a part of rectum bulges into vagina leads to difficult bowel movements.
- Enterocele: the herniation/bulging of vaginal wall (upper rear) where a small portion of bowel bulges into vagina, standing leads to pulling sensation and backache which is relieved by lying down.
Causes of uterine prolapse:
- Conditions that lead to increased pressure in abdomen such as in bronchitis and asthma, straining (in constipation), accumulation of fluid in abdomen (edema), pelvic tumors.
- Being overweight and obese
- Major surgery in pelvic area
- After menopause (weakening and loss of tissue tone)
- Pregnancy, childbirth or difficult delivery through vagina
- Being Caucasian
- Lifting excess weight
- Advancing age
- Increased BMI
- Chronic coughing
- Chronic constipation
- Recurrent bladder infections
- Increased bleeding (vaginal)
- Increased vaginal discharge
- Pulling or heavy feeling in the pelvis
- Problems with sexual intercourse
- Feeling that something is coming out of vagina
- Discomfort walking
- Low back pain
- Difficulty in urination
Uterine prolapse can be diagnosed by evaluating symptoms and performing pelvic exam.
· During this exam, device called speculum is inserted to see inside vagina and examine vaginal canal and uterus.
· To rule out other pelvic problems ultrasound is performed. As a wand is passed and inserted into abdomen and vagina to create sound wave images.
· Due to complete prolapse such as in ureteral obstruction, renal sonography or IVP (intravenous pyelogram) is performed. In this procedure, dye is injected into vein and then X-ray series is performed to view progress through bladder.
· To increase the pressure inn abdomen, patient is asked to cough or strain while lying down.
· Examination in standing position is performed.