What is Uterine Prolapse?

How Does Sagging Occur in the Uterus and Urine Bag?

Prolapse in genital organs is the movement of sexual organs downwards towards the vagina (reservoir) as the bonds fixing these organs in the abdomen lose their edge. Not only the uterus (uterine prolapse), but also the bladder and the pelvic colon located right in the front and at the back of the uterus prolapse together with the uterus. Prolapse of the bladder is called “cystocele” and the prolapse of the large intestine is called “rectocele”. They are classified according to the degree of the prolapse.

These organs, which are normally located in a bone roof, can move only in a limited manner because of the bonds that keep them in place. As age progresses and especially as the number of births given increase, these bonds lose their flexibility and thus, might lead to the prolapse of these bonds into the vagina and although this is usually colloquially referred to as uterus prolapse, all genital organs often prolapse together. Sometimes the prolapse so apparent that the woman can keep the cervix in the entrance of her vagina by hand. In some cases, when the uterus has been neglected, the uterus might even protrude out of the vagina.

Bladder prolapse is the name given to the bulging of the bladder, which is adjacent to the anterior wall of the vagina, inside the vagina. This causes the woman to feel the bulging bladder by hand especially in conditions such as coughing, sneezing, lifting a heavy object which increase intraabdominal pressure. This complaint is usually accompanied by urinary incontinence. Urinary incontinence, in its simplest form, appears only when the patient coughs, sneezes and strains.

With an increase in the severity of the prolapse, urinary incontinence starts appearing in such cases as laughing, sexual intercourse, even standing up, as well. In advanced cases, bladder prolapse leads to the disfigurement of the angle that needs to exist between the bladder and the tract called urethra which transfers the urine from the bladder to the outside, thus, leading to the appearance of urinary incontinence. In advanced and quite rare cases, urine cannot be held at all and the urine arriving at the bladder is directly discharged without being stored in the bladder.

When uterus prolapse exists by itself, it causes the woman to feel pain and fullness in the lower part of her body especially when she stands up, coughs, sneezes and strains. In more advanced cases, the uterus protrudes outside the vagina completely and even if the woman pushes the uterus back with her fingers, it moves out again some time later. Ulcers might appear on it in time.

Rectum (the end of the large intestine) prolapse, on the other hand, is the bulging of the rectum, which is adjacent to anterior wall of the vagina, towards the vagina. Although rectum bladder does not cause any special problems in many cases, it might lead to constipation.

Another problem experienced by women experiencing prolapse in genital organs is that the tears resulting from difficult deliveries lead to enlargement in the vagina. This might cause the woman to have problems in her sex life with her spouse  and the couple not to take pleasure from their sex life as much as they used to.

What are the Risk Factors of Uterine Prolapse?

Some factors might make uterus prolapse easier:

• Having more than one pregnancies and normal deliveries
• Giving birth to a large baby
• Advanced age
• Lifting heavy weights
• Coughing constantly
• Straining in the toilette much
• Obesity, chronical constipation and some lung diseases might help develop uterus prolapse by stretching the muscles and connective tissue at the bottom of the abdominal cavity.

How is the diagnosis of uterine and bladder prolapsed?

Women are generally aware of uterus prolapse. However, whereas organ prolapse might be detected by chance in a woman who has no problems, it is often diagnosed when the prolapse is easily visible during the gynecological examination of a woman experiencing urinary incontinence or “feeling of fullness in the lower region”.

What Are The Treatment Methods For Uterine And Urinary Bag Prolapse?

Treatment of uterus prolapse changes depending on the age of the woman, degree of the disease, general health condition of the woman and whether she wants to give birth to a baby later on. Development of this problem in the future might be prevented, even partially, by doing exercises called Kegel exercises which contract the muscles around the vagina and the perineal muscles regularly.

The treatment method to be implemented in the case of genital organ prolapse in a woman who has completed her family is usually to take the uterus out of the vagina and to tighten the vagina by excising the excesses in the anterior or posterior walls of the vagina. If women who undergo vaginal tightening operation fall pregnant, they must have caesarean delivery instead of normal delivery.

Implementation of different operative techniques might be required to treat the urinary incontinence problems.

Tightening of the vagina, that is repairment of the enlargement by excising the extra tissues on the anterior and posterior walls of the vagina only without excising the uterus, on the other hand, is preferred for a woman who is in the reproductive age and is still willing to give birth or does not accept the excision of her uterus even if she has completed her family. In this way, complaints of women with postdelivery vaginal enlargement complaints will decrease and more satisfaction will be obtained from sex life when compared to the past. Vaginal tightening operation is medically referred to as vaginoplasty.

In case of apparent uterus prolapse, it is possible to abdominally access the bonds that keep the uterus in place, push these bonds upwards thus preventing the excision of the uterus. However, it must be known that the operations, in which the bonds are pushed up, are not very long-lived. Risk of recurrence of the problem within 3-5 years is probable depending on the type of the operation performed and the technique of the performing surgeon.

Another method for treatment of uterus prolapse is to place a rubber structure called pessary into the vagina to keep the uterus in place. Pessary has various types containing air and water. It is not easy to use so it is not preferred.