Uterine prolapse is the displacement of the genitals lower than where they should be. Usually, not only the uterus, but also the urinary bladder and the last part of the large intestine, located just in front of and behind it, also show sagging with the uterus.
Normally, these organs can only move in a limited way thanks to the ligaments that hold them. As age progresses and especially as the number of births increases, these ligaments lose their flexibility and thus they may cause genital organs to sag into the vagina. Sometimes the sagging is so obvious that the woman can feel the cervix with her hand at the entrance of the vagina. Sometimes, the uterus may even go out of the vagina in neglected cases.
Urinary bladder prolapse is the name given to the bulging of the bladder, which is adjacent to the anterior vaginal wall, inside the vagina. This situation causes the woman to feel the concave bladder with her hand, especially in situations that increase intra-abdominal pressure such as coughing, sneezing, lifting a heavy object. This complaint is often, but not always, accompanied by urinary incontinence. Urinary incontinence, in its mildest form, only occurs when coughing, sneezing and straining.
With the increase in the severity of the sagging, the problem of urinary incontinence arises in situations such as laughing, sexual intercourse, and even standing. In advanced cases of bladder sagging, the angle that should be between the urinary bladder and the pipe called the urethra, which transmits the urine from the bag to the outside, deteriorates, thus causing the complaint of urinary incontinence.
When uterine prolapse is alone, it causes the woman to feel pain and fullness in the lower region, especially when standing, coughing, sneezing and straining. Prolapse of the rectum (the last part of the large intestine) is the bulging of the rectum, which is adjacent to the posterior wall of the vagina, towards the vagina. Prolapse of the rectum can cause constipation problem. Another problem of women who have sagging genital organs is that the tears that occur in difficult births cause the complaint of enlargement in the vagina. This situation may cause the woman to have problems in sexual life with her husband, and the couple may not be able to enjoy sexual life as before.
Sagging of the genital organs is especially seen in women who have had multiple and difficult births. Prolonged difficult births result in the stretching of the ligaments holding the genital organs in place, tearing them in some areas, and thus reducing the functions of holding the organs in place. In women who have given birth by cesarean section and women who have never given birth, sagging is much rarer.
How Is It Diagnosed?
Generally, women are aware of uterine prolapse. However, sometimes organ prolapse can be detected incidentally in a woman who has no problems, or it is diagnosed by the gynecological examination of a woman who often experiences urinary incontinence or a “feeling of fullness in the lower region”, when the prolapse is easily seen.
Treatment Methods
Treatment of uterine prolapse depends on the age of the woman, the degree of the disease, the general health of the woman, and whether she wants to have a child later on. The development of this problem in the future can be partially prevented by doing regular Kegel exercises around the vagina and perineum muscles.
In the case of genital organ prolapse in a woman who has completed her family, the treatment method is usually the removal of the uterus from the vagina and the narrowing of the vagina by removing the excess on the anterior and posterior vaginal walls. Women who have undergone vaginal tightening operation should have a cesarean section instead of a normal delivery if they become pregnant.
It may be necessary to use different surgical techniques to treat the urinary incontinence problem. For detailed information on this subject, read the article on urinary incontinence.
In a woman of reproductive age who is still considering giving birth or who does not accept the removal of the uterus even if she has completed her family, only the excess tissue in the anterior and posterior vaginal walls is removed without removing the uterus, and the enlargement is repaired, that is, the vagina is narrowed.
In this way, the complaints of women with postpartum vaginal enlargement will decrease and they will be more satisfied with their sexual life than before.
The vaginal tightening operation is called vaginoplasty in medicine.
In case of significant uterine prolapse, it is possible to reach the ligaments that hold the uterus in place through the abdomen, and to pull these ligaments up so that the uterus is not removed. However, it should be known that pull-up operations are not very long-lasting. Depending on the type of operation and the technique of the surgeon, the risk of recurrence may occur within 3-5 years.
Very rarely, devices called pessaries can be used instead of the operation in women who do not want to have their uterus removed despite having children, or who want to have another child, or in patients who are too old and in poor general condition to be able to carry out the operation to have the uterus removed, but this type of treatment is very special. applied in such cases.
Today, removal of the uterus, which has no function other than carrying a child in women who have completed their family, is the most rational treatment for sagging.
For more detailed information about the uterus removal operation, read the uterus removal article.
