Uterine Prolapse

What is Uterine Prolapse?

Uterine prolapse occurs when the muscles and tissues in the pelvis weaken and the support they provide for the uterus becomes insufficient. This is due to the weakening of the support structures around the uterus. The uterus then falls into the vagina and, in some cases, comes out through the vaginal opening. Mild uterine prolapse does not require treatment, but if the prolapse becomes chronically disturbing, treatment is required. Uterine prolapse is one of several conditions classified under the term pelvic organ prolapse.

What Causes Uterine Prolapse?

Muscles, ligaments, and other structures hold the uterus in the pelvis. When these tissues are weak or stretched, the uterus falls into the vaginal canal. This condition, called prolapse, is more common in women who have had one or more vaginal births. Other factors that can cause uterine prolapse include:

• Pregnancy; multiple births or multiple pregnancies, especially twins or triplets
• Vaginal birth; especially if the baby is large, born quickly, or has a prolonged pushing phase
• Normal aging
• Obesity
• Lack of estrogen after menopause
• Cough that puts pressure on the pelvic muscles, associated with chronic bronchitis, asthma and obesity
• Rarely pelvic tumor
• Repeated straining to have a bowel movement due to long-term constipation can make the problem worse.

What are the symptoms of uterine prolapse?

Although many people with uterine prolapse have no symptoms, some people may experience the following symptoms:

• Feeling of heaviness and pressure in the vagina
• A noticeable swelling, lump or protrusion inside the vagina
• painful sexual intercourse
• urinary incontinence
• Inability to empty the bladder completely
• Backache
• Pain or feeling of pressure in the lower abdomen or pelvis
• Constipation, leaking stool, or straining when moving the bowels
• Bleeding or discharge

What are the Diagnosis Methods for Uterine Prolapse?

Diagnosis of uterine prolapse can be made through a simple procedure that usually does not involve ultrasound or magnetic resonance imaging (MRI), unless the doctor needs to evaluate the degree of prolapse in severe cases. Patients may also be asked for an MRI (magnetic resonance imaging). This procedure allows the healthcare provider to get a good view of the kidneys and other pelvic organs.

How to Treat Uterine Prolapse?

Treatment for uterine prolapse depends on the age and general health of women, whether they want to give birth in the future, and the degree of the disease. The development of this problem in the future can be prevented, at least partially, by doing exercises that exercise the muscles around the vagina and perineum, called Kegel exercises.Vaginal Pesser:
Devices called pessaries, which are placed in the vagina and are mostly made of silicone, are used to support the uterus and keep it up. It may be suitable for women who do not want their uterus removed or who want to give birth to another child. It can also rarely be used in patients who are too old to tolerate the symptoms. In patients who have undergone uterine excision surgery and whose general condition is poor, such treatments can be applied under very special conditions instead of surgery.

• Physiotherapy:
  Physiotherapists can play an important role in the non-surgical treatment of uterine prolapse. In addition to pessary support, pelvic floor muscle training may also be beneficial. It is indicated as the main non-surgical option for women with uterine prolapse.
• Operation:
  Minimally invasive surgical procedures are often used to successfully treat severe cases of uterine prolapse. Surgery decision; It should be given after a detailed discussion with the patient about the desire for vaginal intercourse in the future, the effects of the operation on body image, cultural views, alternative treatments and potential complications.
  In moderate to severe cases, the prolapse may need to be repaired surgically. In laparoscopic surgery, patients' own tissue, donor tissue or synthetic materials can be used to support the structure of the uterus and pelvic floor. A small incision is made in the abdomen and an instrument is inserted through the belly button. The ligaments that hold the uterus in place are reached through the abdomen. It is possible to pull these ties upwards. In this way, there is no need to remove the uterus. However, its chances of success are questionable. Situations requiring repeat surgery may be encountered.
  There are different methods for women of reproductive age who are still considering giving birth. These methods include removing excess tissue from the front and back walls of the vagina without cutting the uterus, repairing the enlargement, and narrowing the vagina. In this way, the symptoms of women who complain of postpartum vaginal enlargement may be reduced.
  In case of genital organ prolapse in a woman who has given birth or does not want to give birth anymore, the treatment method is generally to remove the uterus from the vagina and narrow the vagina by cutting off the excess on the front and back walls of the vagina.
• Estrogen Replacement Therapy (ERT):
  Estrogen replacement therapy (ERT) can prevent further weakening of the pelvic muscles and connective tissue that supports the uterus. There are some side effects, such as increased risk of blood clots, gallbladder disease, and breast cancer.