The uterus is a pelvic organ supported by muscles and ligaments that hold it in place. Estrogen, the main sex hormone in females, also plays a role in keeping the uterus healthy and tight. On the other hand, pregnancy, childbirth and aging contribute to problems of the uterus.
Uterine prolapse is a common condition of the uterus. It happens when the muscles and ligaments that support the uterus weaken, causing the uterus to slip down into the vagina. Uterine prolapse can be mild to severe. Usually, Uterine prolapse is mild enough that it does not cause symptoms or require any treatment. However, a healthcare provider can discuss treatment options if the condition is causing discomfort or disrupting everyday life.
Causes and risk factors:
In addition to age and childbirth, any activity that stresses the pelvic muscles can be a risk factor for uterine prolapse. Causes and risk factors include:
- Age of the mother at the time of childbirth (advanced maternal age presents a higher risk for pelvic floor injuries).
- Prolonged labor and delivery or physical trauma during childbirth.
- Delivering a large baby.
- Decreased estrogen levels after menopause.
- Constipation and persistent straining with bowel movements.
- Chronic cough.
- Regular heavy lifting.
- Previous major pelvic floor surgery.
- Family history.
Mild uterine prolapse is common after childbirth. It generally doesn’t cause symptoms. If a prolapse is moderate to severe, it may cause:
- A heaviness or pulling sensation in the pelvis.
- Being able to see or feel tissue protruding from the vaginal opening.
- Feeling like the bladder is not completely empty after passing urine.
- Leaking urine (incontinence).
- Constipation and needing to press the fingers against the vagina to help evacuate stool.
- Recurring urinary infections
- Feeling like sitting on a small ball.
- Feeling vaginal tissue rubbing on clothing.
- Pain or pressure in the pelvis or lower back.
- Pain or discomfort during sexual intercourse.
- Discomfort walking.
If the uterine prolapse is causing mild or no symptoms, medical treatment is not usually needed and the condition is likely to resolve on its own over time. Special exercises, called Kegel exercises, can strengthen the pelvic floor improving symptoms. These exercises are done by tightening the pelvic muscles as if trying to stop the flow of urine. Management of other contributing health conditions can also help, such as:
- Weight loss
- Constipation treatment
- Cough relief
- Avoiding heavy lifting
- Smoking cessation
Creams or suppository ovules or vaginal rings that contain estrogen may help restore the strength and vitality of the vaginal tissue. This is usually prescribed for postmenopausal women.
Surgery can be indicated depending on the severity of the prolapse, age and plans of becoming pregnant. Surgery can repair the uterus or remove it. During sagging of the vaginal walls, urethra, bladder, or rectum can also be corrected.
If you are a poor candidate for surgery or you don’t want it, you may benefit from wearing a supportive device, called a pessary, in your vaginal canal. Pessaries support the sagging uterus and can be used temporarily or permanently. They come in different shapes and sizes. If a prolapse is severe, a pessary may not help. The downsides of pessaries include irritation of the vagina and a foul-smelling discharge
Uterine inversion is a serious and life-threatening complication of childbirth. It happens when the uterus turns inside out partially or completely. This medical emergency is a rare complication that may cause hemorrhage and shock.
Causes and Risk factors:
Causes of uterine inversion are often related to the placenta failing to completely detach from the uterine wall as it exits the vagina, pulling the uterus outward. Risk factors include:
- Rapid labor or delivery
- Long labor (more than 24 hours)
- Placenta that strongly attaches to the uterus (plcenta accreta)
- Manual removal of the placenta
- Short umbilical cord
- Uterine relaxing medications
- Uterine overdistension
- Delivering a large baby
- First pregnancy, labor, and childbirth
- History of uterine inversion with a previous pregnancy
Most cases of uterine inversion present without any risk factors, making this an unpredictable complication.
Grades of Uterine Inversion:
Uterine inversion severity is determined by how far the top of the uterus has collapsed into the uterus. There are four degrees of uterine inversion:
- Incomplete inversion: The top of the uterus has collapsed, but the uterus does not come through the cervix.
- Complete inversion: The uterus is inside out coming out through the cervix.
- Prolapsed inversion: The fundus is coming out of the vagina.
- Total inversion: The entire uterus and vagina are inside-out, outside of the body.
Treatment is emergent and the options depend on the severity of the inversion. Because the risk of hemorrhage and shock is high, blood transfusion and intravenous fluids are usually needed. Attempts to save the uterus can be made by trying to reinsert it by hand with the aid of muscle relaxants. In the most severe cases, abdominal surgery to reposition the uterus or a complete hysterectomy may be needed.
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