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Womb Prolapse
This terminology denotes descent of the uterus into the vagina.
By common usage, there are 3 degrees of descent, corresponding to mild moderate and severe, to put it in lay terms. In the severe form, the uterus is almost completely outside the vagina. This is seldom seen nowadays due to better medical care and less childbearing.
Why does the womb prolapse?
It is important firstly to understand that the uterus is a very mobile organ in the pelvic cavity of a woman. It is held in place by various supports called ligaments which are made up mainly of fibrous tissues and a small amount of muscle fibres.
These supports are placed under great stress during pregnancy and vaginal delivery. Hence these are the 2 main causes of prolapse of the uterus. Pregnancy by itself will predispose to uterovaginal prolapse in the absence of vaginal delivery. Therefore, elective delivery of all babies by Caesarean Section will not totally prevent this condition.
Other important causes of prolapse of the uterus are age and menopoause, obesity, chronic cough and constipation, pelvic tumours, and physical exertion (eg. jogging, running, aerobics). In a rare situation, congenital weakness of the uterine supports has been implicated in womb prolapse in young women who have not had childbearing.
Symptoms of womb prolapse
  1. Lump or protrusion at the vulva.
  2. Leakage of urine with coughing, sneezing, jumping (stress urinary incontinence SUI). This association between womb prolapse and SUI is very common as the baldder and the uterus are in very close proximity anatomically. Hence descend of the uterus usually brings the bladder down with it.
  3. Inability to empty the bladder easily and in some instances, complete retention of urine. This is in mark contrast to SUI, and occurs in the very severe degree of prolapse when the urinary passage is kinked. It is important to recognise this association, as treating the prolapse by surgery will relief the urinary flow problem, but may unmask an underlying SUI!
  4. Frequency of urination. This is the result of incomplete emptying of the bladder. Residual urine gives rise to infection.
Management
Prevention is the key to management.
The correct management of pregnancy and delivery is paramount. Post-natal pelvic floor exercises should be practised regularly and deligently. Rest and good nutrition are important. If anaemia had developed because of excessive blood loss in the third stage of labour, this must be corrected.
Aging and menopause go hand in hand. In the absence of any medical contraindications, hormonal replacement is helpful in the mild cases. A short course of hormonal treatment is also necessary in preparing a patient for surgery, especially if the patient had been menopausal for sometime, and the vaginal skin is thin and dry.
Avoidance of all the other predisposing causes will help to prevent the occurrence of womb prolapse.
However, in most instances, when the patient presents herself to the gynaecologist, it is the end-stage of the condition, that is, some form of surgical treatment may be necessary.
Surgery for Womb Prolapse
Except in the very severe instance of third degree prolapse of the uterus, conservation of the uterus can be considered. The uterus does not always have to go!
The surgical procedures are many, and include anterior and/or posterior colporrhaphy, Manchester repair, sacro-spinous fixation, laparoscopic procedures, vaginal hysterectomy, to name the common ones. Some form of mesh reinforcement may be required in repair procedures
If SUI is present, a mid-urethral sling or colposuspension (abdominal or laparoscopic) will be needed.
Discuss this with your gynaecologist
Post-operative care is very important as the repaired tissues need time to heal and organise. Generally, a 2 month hiatus from physical activities and sexual episode is recommended.
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Contact Info
6 Napier Road, #07-11
Gleneagles Medical Centre
Singapore 258499
Tel : 6472 2283 (call for appt)
Fax : 6473 5928
Email : seethoclinic@gmail.com