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A delicate support system: Help for uterine prolapse

The uterus is held in place directly above the vagina by a network of muscles and ligaments. But as women age, this support system may weaken. After menopause, when the body no longer produces tissue-strengthening estrogen, this weakening may cause the cervix and uterus to drop toward the vagina, a condition called uterine prolapse. Commonly affected are women who have given birth vaginally, especially if they had many children or endured a long or difficult labor.

Other abdominal pressure or stress may also contribute to uterine prolapse. Women whose jobs require heavy lifting or who are extremely overweight, for example, are at increased risk. Even chronic coughing or chronic constipation can weaken the support structure of the uterus, causing it to drop into the vagina. The condition often runs in families, so a woman whose mother, sister or aunt experienced uterine prolapse may be more prone to the condition herself.

The signs

How can a woman tell that her uterus has dropped? Common symptoms include a feeling of heaviness or fullness in the pelvic area, a bearing-down sensation, a mild backache, painful intercourse and stress incontinence (urine leakage prompted by a cough, laugh, sneeze or exertion such as lifting). In severe cases, the cervix may protrude through the vaginal opening. This makes walking and even standing uncomfortable.

See your gynecologist if you notice such symptoms. He or she will probably do a series of tests, including a pelvic exam, Pap smear, urinalysis and pelvic ultrasound, mainly to rule out any underlying disorders.

Treatment options

A woman’s gynecologist will take a number of factors into account when planning treatment. Her age, overall health, childbirth plans and sexual activity level all come into play.

In mild cases, Kegel exercises may be the only treatment required. These simple exercises strengthen pelvic floor muscles (see box above for instructions). And overweight women may find that shedding excess pounds helps. In women who suffer from constipation, a high-fiber diet can reduce straining and ease abdominal pressure.

In more severe cases, a pessary (a small, rubber, ring-shaped device) is inserted into the vagina to help maintain the uterus in its normal position. Pessaries must be cleaned regularly and checked often for fit. If a woman feels uncomfortable about removing and cleaning the pessary on her own, she must see her gynecologist every six to eight weeks for maintenance.

Hysterectomy, surgical removal of the uterus, may be a consideration for older women whose uterus has dropped significantly or for those who find a pessary bothersome or ineffective. Other women may prefer to undergo pelvic resuspension procedure—surgery in which the supporting ligaments are shortened, strengthened and secured to restore the uterus to its proper position. This surgery is usually performed through the vagina and occasionally through the abdomen.

If you have uterine prolapse, discuss the problem with your gynecologist. Together, you can arrive at the remedy that is best for you.

How to do Kegel exercises

Besides helping cases of uterine prolapse, Kegel exercises prevent or relieve incontinence and keep vaginal tissues strong. To do a Kegel, alternately contract and relax the pelvic floor muscles (you’ll find the muscles by pretending to stop the flow of urine). Do four or five sets of 30 to 40 Kegels a day.