Uterine Prolaps

DESCRIPTION

Pelvic organ prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of prolapse in later life, but because many women don't seek help from their health care provider the actual number of women affected by prolapse is unknown. Prolapse may also be called uterine prolapse, genital prolapse, uterovaginal prolapse, pelvic relaxation, pelvic floor dysfunction, urogenital prolapse or vaginal wall prolapse. Pelvic organ prolapse occurs when the pelvic floor muscles become weak or damaged and can no longer support the pelvic organs. The womb (uterus) is the only organ that actually falls into the vagina. When the bladder and bowel slip out of place, they push up against the walls of the vagina. While prolapse is not considered a life threatening condition it may cause a great deal of discomfort and distress.

Uterine prolapse is a condition that develops when muscular support for the uterus is lost and the uterus has fallen or dropped from its normal location, causing it to bulge into the vagina. The uterus is normally held in place by the pelvic muscles and supporting ligaments. When these muscles become weakened or injured, uterine prolapse can occur. In mild cases, a portion of the uterus descends into the top of the vagina. In more serious cases, the uterus may even protrude through the vaginal opening and outside the vagina. A prolapse can be associated with or accompanied by a urethrocele and cystocele (urethra and/or bladder bulge along the front wall of the vagina) and rectocele (rectal wall bulges into the back wall of the vagina).

TYPES OF PELVIC PROLAPSE

There are a number of different types of prolapse that can occur in a woman's pelvic area and these are divided into three categories according to the part of the vagina they affect: front wall, back wall or top of the vagina. It is not uncommon to have more than one type of prolapse. Prolapse of the Anterior (Front) Vaginal Wall
Cystocele (Bladder Prolapse): When the bladder prolapses, it falls towards the vagina and creates a large bulge in the front vaginal wall. It's common for both the bladder and the urethra (see below) to prolapse together. This is called a cystourethrocele and is the most common type of prolapse in women.

Urethrocele (Prolapse of the Urethra): When the urethra (the tube that carries urine from the bladder) slips out of place, it also pushes against the front of the vaginal wall, but lower down, near the opening of the vagina. This usually happens together with a cystocele (see above).

Prolapse of the Posterior (Back) Vaginal Wall
Enterocele (Prolapse of the Small Bowel): Part of the small intestine that lies just behind the uterus (in a space called the pouch of Douglas) may slip down between the rectum and the back wall of the vagina. This often occurs at the same time as a rectocele or uterine prolapse (see below).
Rectocele (Prolapse of the Rectum or Large Bowel): This occurs when the end of the large bowel (rectum) loses support and bulges into the back wall of the vagina. It is different from a rectal prolapse (when the rectum falls out of the anus).

Vaginal Vault Prolapse: The vaginal vault is the top of the vagina. It can only fall in on itself after a woman's womb has been removed (hysterectomy). Vault prolapse occurs in about 15% of women who have had a hysterectomy for uterine prolapse, and in about 1% of women who have had a hysterectomy for other reasons.

http://www.moondragon.org/obgyn/disorders/uterineprolapse.html

Pelvic Floor Exercises (Kegel Exercises)

Pelvic floor exercises help prevent prolapse by strengthening the muscles that support the pelvic organs. The exercises are easy and quick to do, but it's important to do them correctly, and many women benefit from guidance from a physiotherapist. Start by locating the muscles you need to exercise.

There are a few different ways to do this:

Place one or two fingers in your vagina and squeeze your muscles until you can feel your vagina tighten around your fingers. These are your pelvic muscles. Imagine you're trying to stop the flow of urine mid-stream. The muscles you tighten (contract) are your pelvic floor muscles.

The other way to identify the correct muscles is to imagine you are trying to stop yourself from passing gas. The muscles you squeeze to do this are your pelvic muscles. Once you've identified the correct muscles you're ready to begin. The exercises can be done while lying down, sitting or standing, with your knees together or slightly apart. Set 1 - Slowly tighten your pelvic floor muscles and count to four, then let the muscles relax for a count of four.

As your muscles get stronger gradually increase the count to 10. Try to repeat this 10 to 15 times. Check that you're not tightening the muscles in your legs, abdomen or buttocks, as it's important to use only your pelvic muscles. Remember to keep breathing. Set 2 - Now tighten and relax your pelvic muscles as quickly as you can, again 10 to 15 times. As a preventive measure, try to do the exercises two or three times a day. If you have a prolapse, you may be advised to increase the number of times you do the exercises, but don't overdo it. Excessive exercising of the pelvic muscles can cause muscle fatigue and make the exercises less effective.

You can do the exercises anywhere, anytime, but studies show that when women do them at home, they are more likely to do them correctly. Some women find it helps to set aside specific times to do the exercises, such as before getting out of bed in the morning and before going to sleep at night. If you think you're doing the exercises incorrectly or need help locating your pelvic floor muscles, a physiotherapist will be able to help you. Ask your health care provider for a referral.

Hysterectomy - The Successful remedy for uterine disorders

Hysterectomy as you might have heard that it is a surgical procedure for treating enlarged uterus or uterine fibroids. Hysterectomy is supposed to be one of the last options for the treatment of uterine disorders. It is a surgical procedure wherein the affected uterus is removed. It is usually done by a gynecologist.

Hysterectomy is done in either of the two ways: partial also known as supra-cervical or total where in the whole of the uterus is removed. In several cases surgical removal of the ovaries is also done along with hysterectomy. Then the surgery is called "total abdominal hysterectomy with bilateral salpingo-oophorectomy" (sometimes abbreviated TAH-BSO). The type of surgery that is done depends on the reason for the surgery.

Most often hysterectomy is used colloquially yet mistakenly for referring the removal of any parts of the female reproductive system. Hysterectomy as I have mentioned earlier is done in two ways. The later one is seldom done as it is the radical method of treatment where the affected organ, not the affected parts is removed from the patient’s body.

Though it is a bit rare but facts are really surprising which have shown up after research. In the United States, 1 out of 3 women can be expected to have a hysterectomy by age 60. There are 22 million women alive in the United States whose female organs have been surgically removed. It is the second most common surgery among women in the United States.

You probably would like to know more about hysterectomy. More details about hysterectomy have been provided in the next sections. Our next section deals with Hysterectomy surgery. I Hope it will help you.

http://www.direct-healthcare.com/hysterectomy.htm

Laparoscopic Surgery for Uterovaginal and Vaginal Prolapse

The prolapse of uterus and vagina is one of the most frustrating and embarrassing disorders confronting the modern woman, who, with increased life expectancy, is interested in maintaining her femininity and capacity for sexual activity.

A prolapsed uterus or vagina is just a manifestation of the break down in the pelvic floor supporting system, and it is nearly coexists with other type of genital prolapse such as cystocele, rectocele, and enterocele. Therefore, the reconstructive surgery for uterovaginal or vaginal prolapse is just a part of the total repair of the pelvic floor, which is necessary for restoration of the normal anatomy and function. The length of the vagina in a normal adult female is approximately 10 - 12 cm.

In a standing female, her lower 1/3 of the vagina is pointing 90 degree to the floor and her upper 2/3 of vagina is in an angle almost parallel to the floor and directly toward her lower backbone. The vagina is basically supported on three different levels in the pelvis. The support of the upper 1/3 of vagina comes from the uterosacral ligaments, a pair of very strong fibromuscular structures that originate from lateral aspects of sacrum (the lowest part of our spine), going around the rectum and attaching to the cervix (the mouth of womb), and upper part of vagina.

These ligaments pull the top of vagina and cervix toward the sacrum and forms the normal axis of vagina. The middle third of the vagina is held in place by the lateral attachments of the fascia to the pelvic side wall. The lower third of vagina is blending into and merging with the fibromuscular tissue surrounding the opening of the vagina and anus.

It is of utmost importance for the readers to understand that the uterus, per se, has no bearing or effect on the vaginal support. In other words, a hysterectomy should not be considered as part of repair surgery for uterovaginal or vaginal prolapse unless there is distinct pathology of the uterus. In order to restore the vaginal depth and axis, all three levels of support must be attended at the time of surgery.

What is a Prolapsed Uterus?

Uterine prolapse, or a prolapsed uteus, is a specific type of pelvic organ prolapse that occurs when the uterus drops from its normal position in the pelvic cavity and descends into and sometimes outside the vagina in the most serious cases. To better understand uterine prolapse, it may be helpful to think of it as a type of hernia. For example, weakness in the abdominal wall can lead to intestines bulging through the muscular support causing an abdominal hernia.

Similarly, weakness in the muscles and ligaments of the pelvic floor can cause loss of uterine support and lead to uterine prolapse. Pregnancy, childbirth, obesity and chronic coughing and lifting are some of the factors that predispose a woman to developing uterine prolapse. Uterine prolapse is a progressive condition that gets worse over time, if not treated.






Hysterectomy has been considered the treatment of choice for women experiencing significant symptoms as a result of uterine prolapse. In fact, the significance of uterine prolapse as a woman's health care issue can be gauged by the fact that it was the third most frequently reported cause for hysterectomy in the U.S. from 1993-1998, accounting for 548,657 procedures during the time frame.

1 It was the most common reason for hysterectomy in women older than 55 years in a second large-scale survery.

2 . Although uterine prolapse typically occurs in post-menopausal women it also occurs in younger women. Definitive treatment has been difficult in women who have not completed childbearing. It has also been an issue in women who wish to preserve their uterus for other reasons.

http://www.inletmedical.org/prolapsed_uterus.asp

Images : Uterine Prolaps

Anatomy of the pelvic floor showing the divisions of levator ani

ICS prolapse scoring system (POPQ)

Uterine prolapse. This photograph shows a woman with advanced uterine prolapse. Note the ulcerated, thickened vaginal mucosa which results from rubbing on underclothes


Source : http://www.indianjurol.com/getarticleimages.asp?a=IndianJUrol_2006_22_4_310_29113