Uterine prolapse is a condition that can occur in women of any age; however, doctors say that it often affects postmenopausal women who have had one or more vaginal deliveries. Research shows that among women aged 55 years and above, it is one of the common reasons for undergoing a hysterectomy. (This is a surgical procedure in which the womb (uterus) is removed.) According to Dr Mohamed Okasha, a gynaecologist obstetrician at Legacy Clinics, Kigali, a prolapsed uterus is when it moves downward from its normal position, this can happen when the tissues that normally support the uterus (the pelvic floor muscles and ligaments) become stretched and weak. SYMPTOMS He says it can be mild, moderate or severe. With mild and moderate degrees, the symptoms can be pelvic pain, urinary symptoms like frequency of urine or voiding difficulties; sometimes it can be associated with loss of urine control. The severe degree, the patient usually feels a mass protruding out of her vagina. He explains that some other symptoms of uterine prolapse are; pelvic heaviness or an increase in vaginal discharge, difficulties with sexual intercourse, urinary leakage, retention or bladder infections, bowel movement difficulties, such as constipation, lower back pain, uterine protrusion from the vaginal opening, sensations of sitting on a ball or that something is falling out of the vagina and weak vaginal tissue. CAUSES Okasha stresses that the condition rarely can happen congenitally; however, the most common reason is the trauma during birth. He adds that delivering a large baby, or having a vaginal delivery is a big risk. If the pushing stage during labour was prolonged, or if the delivery was by forceps or resulted in a third-degree tear (a tear into the tissues of the anus or back passage) or if you have had multiple vaginal births, you can be at risk of uterine prolapse. He says, “Getting older, especially after menopause, when levels of circulating estrogen drop, frequent heavy lifting, straining during bowel movements, chronic coughing, a history of pelvic surgery, genetic factors leading to weakened connective tissue can be a cause of uterine prolapse.” Okasha notes that being overweight or obese increases your risk of prolapsed uterus. Falling of muscles, ligaments and connective tissue that occurs with age and low levels of oestrogen after menopause can affect the tissues that hold the uterus in place. Increased pressure within the abdomen, which often happens with constipation and straining on the toilet, chronic (ongoing) cough and frequent heavy lifting, an inherited tendency to weakness in the ligaments and other connective tissues, can all lead to uterine prolapse, he says. TREATMENT Experts say that exercises are very important, that is to say, mild uterine prolapse can be treated with Kegel exercises, weight management and avoidance of heavy lifting. These exercises can be done anywhere and at any time and can help strengthen the muscles of the pelvic floor. According to Mayo Clinic, to reduce your risk of uterine prolapse, try to; treat and prevent constipation. Drink plenty of fluids and eat high-fibre foods, such as fruits, vegetables, beans and whole-grain cereals. Avoid heavy lifting and lift correctly. When lifting, use your legs instead of your waist or back. Control coughing. Get treatment for a chronic cough or bronchitis, and avoid smoking or gaining weight. Talk with your doctor to determine your ideal weight and get advice on weight-loss strategies, if you need them. editor@newtimesrwanda.com
