Uterine & vaginal disorders
Uterine And Bladder Prolapse
The uterus and the bladder are held in their normal positions just above the inside end of the vagina by a "hammock" made up of supportive muscles and ligaments. Wear and tear on these supportive structures in the pelvis can allow the bottom of the uterus, the floor of the bladder or both to sag through the muscle and ligament layers.
When this occurs, the uterus or bladder can create a bulge into the vagina. In severe cases, it is possible for the sagging uterus or bladder to work its way down far enough that the bulge can appear at the vagina's opening or even protrude from the opening.
When the uterus sags downward, it is called uterine prolapse. When the bladder sags, it is called bladder prolapse, also known as a cystocele.
Various stresses can cause the pelvic muscles and ligaments to weaken and lead to uterine or bladder prolapse. The most significant stress on these muscles and ligaments is childbirth. Women who have had multiple pregnancies and vaginal delivery are more likely to develop prolapse.
Other stresses that can lead to prolapse include constipation with a habit of frequent straining to pass stool and a chronic cough. Obesity also can strain the pelvic muscles.
Support problems in the pelvis become worse after menopause because the pelvic tissues depend on estrogen to help them keep their tone, and estrogen levels drop after menopause.
Some doctors estimate that half of all women have some degree of uterine or bladder prolapse in the years following childbirth. For most women, these conditions remain undiagnosed and untreated. Only 10% to 20% of women with pelvic prolapse seek medical evaluation for symptoms.
bladder or uterine prolapse symptoms
Mild cases of bladder or uterine prolapse usually don't cause any symptoms. A prolapse that is more advanced can cause any of the following symptoms:
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Discomfort in the vagina, pelvis, lower abdomen, groin or lower back. The discomfort associated with prolapse often is described as a pulling or aching sensation. It can be worse during sexual intercourse or menstruation.
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Heaviness or pressure in the vaginal area. Some women feel like something is about to fall out of the vagina.
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A bulge of moist pink tissue from the vagina. This exposed tissue may be irritated and cause itching or small sores that can bleed.
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Leakage of urine, which can be worse with heavy lifting, coughing, laughing or sneezing
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Frequent urination or a frequent urge to urinate
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Frequent urinary tract infections, because the bladder can't empty completely when you urinate
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A need to push your fingers into your vagina, into your rectum, or against the skin near your vagina to empty your bladder or have a bowel movement
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Difficulty having a bowel movement
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Pain with sexual intercourse, urine leakage during sex, or an inability to have an orgasm
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Moist discharge that soils your undergarments
Uterine or bladder prolapse Diagnosis
Our obstetrician-gynecologist can diagnose uterine or bladder prolapse with a pelvic examination. Occasionally, an MRI test may be needed to confirm the diagnosis.
In some cases, especially if you are having frequent urinary infections or if you are having difficulty holding your urine, your doctor may order one or more tests to evaluate your bladder function.
Urodynamic studies test your bladder function and can show if your bladder empties completely. The pressure inside your bladder is measured as fluid is passed into it through a small tube. An X-ray video taken after dye is inserted through your urethra to fill your bladder can show whether its shape is distorted. This test is known as a voiding cystourethrogram.
Uterine or bladder prolapse Treatment
Treatment depends on the severity of uterine prolapse. Your doctor might recommend:
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Self-care measures. If your uterine prolapse causes few or no symptoms, simple self-care measures may provide relief or help prevent worsening prolapse. Self-care measures include performing Kegel exercises to strengthen your pelvic muscles, losing weight and treating constipation.
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Pessary. A vaginal pessary is a plastic or rubber ring inserted into your vagina to support the bulging tissues. A pessary must be removed regularly for cleaning.
Uterine or bladder prolapse Surgery
Your doctor might recommend surgery to repair uterine prolapse. Minimally invasive (laparoscopic) or vaginal surgery might be an option.
Surgery can involve:
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Repair of weakened pelvic floor tissues. This surgery is generally approached through the vagina but sometimes through the abdomen. The surgeon might graft your own tissue, donor tissue or a synthetic material onto weakened pelvic floor structures to support your pelvic organs.
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Removal of your uterus (hysterectomy). Hysterectomy might be recommended for uterine prolapse in certain instances. A hysterectomy is generally very safe, but with any surgery comes the risk of complications.
Talk with your doctor about all your treatment options to be sure you understand the risks and benefits of each so that you can choose what's best for you.
Lifestyle and home remedies
Depending on the severity of your uterine prolapse, self-care measures may provide relief. Try to:
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Perform Kegel exercises to strengthen pelvic muscles and support the weakened fascia
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Avoid constipation by eating high-fiber foods and drinking plenty of fluids
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Avoid bearing down to move your bowels
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Avoid heavy lifting
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Control coughing
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Lose weight if you're overweight or obese
Kegel exercises
Kegel exercises strengthen your pelvic floor muscles. A strong pelvic floor provides better support for your pelvic organs, prevents prolapse from worsening and relieves symptoms associated with uterine prolapse.
To perform Kegel exercises:
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Tighten (contract) your pelvic floor muscles as though you were trying to prevent passing gas.
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Hold the contraction for five seconds, and then relax for five seconds. If this is too difficult, start by holding for two seconds and relaxing for three seconds.
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Work up to holding the contractions for 10 seconds at a time.
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Aim for at least three sets of 10 repetitions each day.
Kegel exercises may be most successful when they're taught by a physical therapist and reinforced with biofeedback. Biofeedback involves using monitoring devices that help ensure you're tightening the muscles properly for the best length of time.
Once you've learned the proper method, you can do Kegel exercises discreetly just about anytime, whether you're sitting at your desk or relaxing on the couch.