Childbirth and other things can weaken the female pelvic area. Many don’t notice a difference immediately, but over time, problems can develop.
The most common is uterine prolapse. The uterus stays in position in the pelvis by muscles, special ligaments, and other tissue. When these muscles and connective tissues deteriorate, the uterus actually slips from these supports and begins moving down in the vagina, until it actually protrudes out through the vulva.
Uterine prolapse varies in severity. Mild uterine prolapse may show no signs or symptoms. Moderate to severe uterine prolapse can cause women to experience a pressure and heaviness in the pelvic area. Tissue can protrude from the vagina. There can be urinary difficulties, such as leakage, retention or trouble with bowel movements. Other symptoms include low back pain, painful sexual intercourse, the sensation of sitting on a small ball or that something is falling out of the vagina. There can be sexual issues such as looseness in the vaginal tissue.
Many of the symptoms get worse after standing or sitting for long periods of time.
Uterine prolapse usually happens in women who have had one or more vaginal births; trauma during childbirth, with large babies or difficult labor and delivery. Normal aging and lack of estrogen after menopause can also cause uterine prolapse.
Obesity, frequent heavy lifting, chronic coughing and frequent straining during bowel movements can all place a strain on the muscles and connective tissue in your pelvis and may play a role in the development of uterine prolapse.
Uterine prolapse doesn't require treatment unless it's severe. Lifestyle changes may lessen symptoms of uterine prolapse. Maintaining a healthy weight can minimize the pressure on supportive pelvic structures. Performing Kegel exercises will strengthen pelvic floor muscles. Work to prevent chronic cough. If the cough is due to smoking, smoking cessation is recommended.
Another option is a supportive device called a vaginal pessary. It’s a rubber or plastic donut-shaped device, inserted into the vagina to hold the uterus in place.
If lifestyle changes don’t work or if you don’t want to use a pessary, surgery is an option.
Surgical repair of uterine prolapse usually requires vaginal hysterectomy to remove the uterus and excess vaginal tissue. Vaginal surgery tends to have less pain after surgery, faster recovery and a better cosmetic result. However, it may not provide as long lasting a fix as abdominal surgery. And if you don't have your uterus removed during surgery, prolapse can recur.
Many women are often embarrassed to talk uterine prolapse. They shouldn’t be. Talk about it with your doctor.
Dr. Deborah Wilson