ask: uterus come down

Dear Anon

Thank you very much for your question and welcome!

In terms of what to do, we need to understand what your doctor means by telling you that your uterus is "coming down". Was this the term he used?

Since I don't have any more information from you, I'll assume (and please let me know if I'm wrong) that he was talking about a prolapsed (or dropped) uterus.

Our Encyclopedia describes this condition as "when the uterus (womb) slips out of place and into the vaginal canal due to weakening of the muscles and ligaments of the lower abdomen (called the "pelvic floor"), which normally support the uterus and other organs in the pelvis. The severity of uterine prolapse is defined as:

* First degree (mild)—the cervix (the lower opening of the uterus into the vagina) protrudes into the lower third of the vagina
* Second degree (moderate)—the cervix protrudes past the vaginal opening
* Third degree (severe)—the entire uterus protrudes past the vaginal opening

Anon, your pain may be symptomatic of this. Signs of a prolapsed uterus include

◦Sensation of fullness in the vagina
◦Sensation of pulling in the pelvis
◦Pain in the vagina, lower back, or lower abdomen
◦Vaginal discharge
◦Leakage of urine
◦Difficulty voiding urine
◦Frequent urinary tract infections
◦Protrusion of pink tissue from the vagina that may be irritated or itchy

Besides your pain, do any of the above symptoms feel familiar to you?

There are many treatment options to look into, as well as possible complications from some of the treatments:

Treatment may include:

Kegel Exercises
For mild cases of uterine prolapse, Kegel exercises are recommended to strengthen the pelvic muscles. These exercises are easy to do and can be done anywhere, at any time. To perform Kegel exercises:

◦Squeeze the pelvic muscles as though you are trying to hold back urine.
◦Hold this position for a count of ten, then release slowly.
◦Do this ten times, four times daily.

Referral to a Specialist
You may be referred to a gynecologist or a urogynecologist for further evaluation or surgery.

Pessary Insertion
This is a rubbery, doughnut-shaped device. It is inserted by your doctor into the upper portion of the vagina. A pessary helps to prop up the uterus and bladder, and temporarily prevents sagging into the vagina. It will need to be removed for cleaning and before sexual intercourse.

Surgery
Surgery may be necessary to correct uterine prolapse. These procedures are generally not done until you have finished having children. Surgical procedures include:

◦Vaginal hysterectomy —removal of the uterus through the vagina. This procedure will permanently resolve uterine prolapse, but also results in infertility .
◦Vaginal repair—This is usually done with a hysterectomy. The repair can be done with sutures and with insertion of mesh or slings.
◦Colpocleisis—This is a procedure that cures the prolapse, but results in a foreshortened vagina that will not permit intercourse.

You and your doctor should discuss all risks and benefits when considering these surgical options.

Complications
Urinary tract infections and other urinary symptoms may occur due to the frequently associated cystocele . This is a hernia-like disorder in women that occurs when the wall between the bladder and the vagina weakens, causing the bladder to drop or sag into the vagina.

Constipation and hemorrhoids may also occur as a result of the associated rectocele (a similar condition to cystocele, only the rectum protrudes into the vagina).

In more severe cases of prolapse, ulceration and infection may occur.

Anon - Your doctor should have talked to you about your options. Did he not discuss this with you? Depending on the severity of your prolapse, you can decide the option that fits you best.

Please make another appointment with him and ask him to take some time to explain your condition to you (in a language you understand and that's not full of medical jargon!) and go through your options. You won't really know what's best for you until you know your situation properly.

I hope this explains things to you and will you please update us and tell us what your doctor said? You should be given as much information as possible, in terms you are comfortable with. Anything else will bring on worry and confusion that is not good for you, physically or emotionally.

I'll look out for your update, we look forward to hearing more from you!