Dr Meeta Nakhare
Uterine Prolapse is an un-voiced symptom where the patient suffers but does not complain. Some studies show that one in eight women suffers from prolapse symptoms. Fifty per cent of women above 50 years of age have some degree of pelvic organ prolapse.
What is a prolapse?
Uterine prolapse is the abnormal descent of the uterus below its normal anatomical position. It is like a hernia. It is usually associated with the descent of the urinary bladder and the back passage. There are three main areas where this type of prolapse occurs. The front vaginal wall, the back vaginal wall, and the top of the vagina.
Prolapse can occur due to congenital weakness of the pelvic floor and connective tissue disorders, various collagen diseases, anatomical defects difficult and traumatic childbirth multiple and frequent vaginal childbirths instrumental delivery, use of forceps at the time of delivery, chronic disorders, constipation, straining, chronic airway obstruction, abdominal tumours, obesity, smoking heavy lifting, menopause use of steroids.
Symptoms
A good gynaecological examination can diagnose the condition, but usually, the symptoms are lower backache, a dragging sensation in the lower pelvic area, feeling of something coming out of the vagina or a lump lower down, incomplete evacuation of bladder frequent desire to pass urine/painful urination, constipation, excessive vaginal discharge, bleeding.
Prevention
You can prevent prolapse by reducing your body weight. Avoid constipation, heavy lifting and straining to strengthen the pelvic floor, you could do kegel exercises. Also, immediately after childbirth, go for intensive physiotherapy to prevent prolapse. Regular medical check-ups are mandatory and if you suspect prolapse meet your gynaecologist before further deterioration.
Treatment
Depending on the age of the patient, if she wants to have more pregnancies, the treatment options can be conservative or surgical. Conservative measures are used when the prolapse is in the early stage or the patient is medically unfit for surgery. Conservative measures include the use of a ring-like pessary (a mmall plastic or silicone medical device which is inserted into the vagina) use of oestrogen creams and good pelvic floor exercises. What is also important is adequate counselling and motivation of patients.
Various types of surgeries are available for prolapse treatment. Your gynaecologist will decide on the type of surgery, which is tailor-made for the patient depending on what part is prolapsed, the degree of prolapse and whether the uterus is to be conserved or removed. Surgery is mainly done from down below but may be down through the abdomen or using the endoscope. Newer modalities include the use of mesh and special tapes.
The author is a well-known obstetrician and gynaecologist. She is currently attached to Pune's Lokmanya Hospital.
