Op. Dr. Âzer Aras Uluğ
Op. Dr. Âzer Aras Uluğ

What is Uterine Prolapse, Symptoms

What is Uterine Prolapse, Symptoms

What is uterine prolapse and what are the symptoms?

The network of muscles, ligaments and skin around a woman's vagina is formed as a result of the weakening of the nerves, muscles and fascia that hold the pelvic organs, tissues and structures in place and provide support. and as a result, sagging towards the vagina and protrusion from the vagina occurs and we call this condition vaginal prolapse (prolapse).

Pelvic organ prolapse, that is, the prolapse of the uterus and other organs into the urinary bladder and intestines, is a gynecological problem that affects women's daily activities and reduces their quality of life and negatively affects their sexual life. It is more common in women who have had one or more vaginal births.

It is especially more common if there is a prolonged labor. However, these sagging can also occur in women who have never had children. The woman can benefit from treatment with an operation.

How is uterine prolapse detected?

Patients usually do not recognize vaginal prolapse. However, in recent years, we have been experiencing an increase in awareness in this direction with an interest in genital aesthetics. Patients now examine their external genitals with a long mirror. They express their discomfort due to the growth, sagging, darkening and asymmetry of their inner labia and want to get rid of this situation.

At the same time, most women express during this self-examination that they have not seen the inside of the vagina before and that they are uncomfortable with the sight of this pink tissue after childbirth. They say that they have frequent vaginal infections and fungal problems due to the wide vaginal opening.

Some women and women who know themselves before marriage, before childbirth or who are familiar with their genital anatomy and examine themselves intermittently with their hands know that there is an abnormality. The most common symptom is a feeling of dislocation of tissues or structures inside the vagina.

The inside of the vagina can be seen when it should not be seen from the outside. During intercourse, a ballooning is felt coming out of the vagina.

  • A feeling of heaviness or fullness in the pelvic area,
  • Sagging tissues that form outward from the vagina,
  • Problems with bowel activity (defecation problems),
  • Urinary Incontinence Problems (urine leakage during coughing, sneezing, exercise, etc.),
  • Low back pain
  • Painful sexual intercourse (dyspareunia),
  • Sexual aversion,
  • Gas coming from the vagina during sexual intercourse,
  • Feeling like something is falling down the vagina.

Patients who come to us with this complaint often say that the above problems increase when they stand for a long time. Prolapse levels can be exacerbated in patients with coughing illnesses such as asthma, heavy lifting or straining conditions such as constipation.

Types of Vaginal Prolapse

Types of vaginal prolapse are as follows;

1-Rectocele (rectal prolapse): This type of vaginal prolapse involves the prolapse of the back wall of the vagina (rectovaginal fascia). When this wall weakens, the rectal wall pushes against the vaginal wall and can create a bulge. In this case, it can become especially noticeable during defecation.

2-Cystocele (bladder prolapse, bladder drop): This occurs when the anterior wall of the vagina (pubocervical fascia) sags. This means that the bladder can prolapse into the vagina. Afterwards, the urethra (urinary tract) usually also prolapses. This phenomenon is called urethral prolapse urethrocele. If both the bladder and urethra prolapse, a cystourethrocele occurs. Urinary stress incontinence (urine leakage during coughing, sneezing, exercise, etc.) is the most common symptom.

3-Enterocele (herniated small intestine): This type of vaginal prolapse can be caused by weakening of the upper vaginal supports. This occurs after hysterectomy. When the anterior and posterior walls of the vagina separate, it causes the intestines to push against the vaginal skin and an enterocele forms.

4-Uterine prolapse (prolapse uteri): It is a weakening of a group of ligaments called uterosacral ligaments, which are located at the top of the vagina. It can cause the uterus to fall and often weaken the front and back walls of the vagina.

Loosening of the vagina is accompanied by additional problems such as urinary incontinence and some sexual problems during intercourse. The tissues begin to prolapse outside the vagina.

Can uterine prolapse be seen from the outside?

Depending on the level of prolapse, it can be seen from the outside. We urogynecologists determine the level of cystocele rectocele and uterine prolapse by vaginal examination with an examination we call Pop Q examination and create a treatment plan accordingly. When our patients sit on the toilet, they describe tissue sagging from the vagina, excess vaginal tissues and ballooning.

Stages of Uterine Prolapse

  • First degree prolapse: The uterus descends into the upper part of the vagina.
  • Second degree prolapse: The uterus descends into the lower part of the vagina.
  • Third degree prolapse: The cervix in the lower part of the uterus prolapses into the vaginal opening and comes out of the body. This can also be called prolapse or complete uterine prolapse.
  • Fourth degree prolapse: The entire uterus prolapses completely out of the vagina. This can also be called prolapse or complete uterine prolapse.

What is good for uterine prolapse?

  • Not lifting heavy weights,
  • Eating a healthy and balanced diet,
  • Doing sports
  • Riding a horse
  • Avoid exercises such as jumping on a trampoline.

First of all, if you have such a condition, you should consult a urogynecologist who deals with the peivic floor.

Vagina Sagging Treatment Turkey

The patient's physical examination and history are important for your doctor to make a definitive diagnosis of the type of vaginal prolapse. For this reason, your doctor will then decide which type of treatment is appropriate for the evaluation and prevention of problematic symptoms and complications caused by the weakening of the tissues and muscles inside the vagina. Vaginal prolapse is a life-threatening condition and, depending on the severity of the prolapse, can only be completely corrected by surgery.

Patients undergoing surgery for vaginal prolapse repair normally require hospitalization for 1-2 days, depending on the type and size of the operation. After the operation, women are usually advised to avoid heavy lifting for approximately 6-8 weeks.

The appropriate treatment option for vaginal prolapse depends on factors such as the cause and severity of the prolapse, the woman's sexual activity and the patient's treatment preferences. In addition, surgical intervention is not performed in women who are not sexually active, who have a barrier to surgery or who have very few symptoms of this phenomenon.

Activity changes: Avoiding heavy lifting or straining.

Kegel exercises: These are exercises used to strengthen the pelvic floor muscles and are one of the treatment options used especially in cases of mild or moderate vaginal prolapse or severe prolapse. Physiotherapy methods such as electrical stimulation and biofeedback are also used to strengthen the pelvic muscles.

Peser: This is a small device that is usually inserted into the vagina and is the most suitable choice for patients who are not sexually active and cannot undergo surgery (pregnant women and those in poor health). These pessaries should be removed and cleaned regularly to prevent infection. Estrogen creams are also widely used to prevent erosion of the vaginal wall and infections. Estrogen helps to strengthen and protect the muscles inside the vagina.

Medications: Another treatment option and used in estrogen replacement therapy to help the body strengthen the muscles in and around the vagina. Women going through menopause do not naturally produce estrogen and the muscles of the vagina weaken. In this case, estrogen may be prescribed for mild symptoms of vaginal prolapse. Some women find that their symptoms improve by exercising, changing their diet, keeping their weight under control, avoiding heavy lifting and straining. Medication or the use of a device called a pessary may also be useful in this treatment.

Update Date: 15.08.2022
Op. Dr. Âzer Aras Uluğ
Op. Dr. Azer Aras Uluğ
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