Uterine Prolapse
Uterine Prolapse
Win the Battle against Gravity
You might call uterine prolapse women's number one health secret. A prolapsed uterus occurs when the uterus loses the battle against gravity and descends into the vagina. And women are understandably reticent about mentioning the problem, even to their closest friends.
"Women don't talk to their friends about this one," says Linda Brubaker, M.D., director of the Section of Urogynecology and Reconstructive Pelvic Surgery at Rush-Presbyterian-St. Luke's Medical Center in Chicago. "They talk about their funny periods, they talk about their breast cancer, but they can't talk about the fact that their innards are starting to hang out through their vagina. There aren't any support groups for this. They feel, 'Oh dear, I'm really different from anybody else.' There's a real sense of vulnerability."
When To See A Doctor
Vaginitis refers to a number of different problems, all of which are easy to cure. But women doctors say that the correct treatment depends on getting the right diagnosis. Untreated vaginitis can lead to pelvic inflammatory disease, which can result in infertility. See your doctor if you notice any of the following: * Pain or itching in your vagina and in the area of your vulva, the lips outside your vagina * Reddening of your vulva * Pain that is especially noticeable when you urinate or during sex, or pain that worsens upon urination or during sexual intercourse * Greenish-yellow, frothy and foul-smelling discharge (which suggests trichomoniasis, a sexually transmitted organism) * Foul-smelling, thin, white or blood-streaked discharge (which may signal atrophic vaginitis) * Heavy, white, thick and odorless vaginal discharge (which could mean a yeast infection) * White or gray and fishy smelling vaginal discharge (which suggests bacterial vaginosis) You should also be screened for bacterial vaginosis if you're pregnant, as it is a common, but preventable, cause of prematurely delivering an undersized baby.
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Uterine prolapse isn't the same as a retroverted, or tipped, uterus that tips back toward the rectum, a position that is perfectly normal in up to one-third of women. But even uterine prolapse is actually pretty common--even if you've never heard of it.
In a mild case of uterine prolapse, just a portion of the organ has descended. In an extreme case the uterus has fallen so far that you can actually see it protruding from your vagina. Making matters worse, the condition rarely occurs in isolation, because the uterus lives in the same neighborhood and shares a support muscle system with the vagina, bladder and rectum. When the uterus shifts, its neighbors can get bent out of shape, too. The bladder, for instance, can get dragged down or squeezed, which leads to incontinence problems.
Uterine prolapse is primarily a consequence of childbirth, "especially if a woman had to push for hours," says Yvonne S. Thornton, M.D., visiting associate physician at the Rockefeller University Hospital in New York City and director of Perinatal Diagnostic Testing Center at Morristown Memorial Hospital in New Jersey. "The baby's head ends up acting as a kind of a battering ram against the perineal muscle between the vagina and the anus, stressing it along with the ligaments that support the uterus."
HOLD ON TO YOUR UTERUS
About one out of every ten women will have surgery for some type of prolapse some time in her life, says Dr. Brubaker. While you and your doctor determine the best course of treatment, here are a few things that women doctors say you can do to keep the problem from getting worse--or maybe even from developing in the first place.
Do Kegel exercises. "It's very unusual to see a woman with extremely strong pelvic muscles who has uterine prolapse," says Dr. Brubaker. The uterus and other pelvic structures--like the bladder--are held in place by muscles. When these muscles are weak or damaged, the job of supporting the uterus falls to the connective muscle ligaments. They, too, can get damaged and prolapse can result. So can bladder incontinence--accidental urine leaks.
"Think of your uterus as an ocean liner tied up at a dock," suggests Dr. Brubaker. "The water that's holding that ocean liner up is the muscle, and then you have these ropes--the ligaments--tying it to the dock. Those ropes can't hold it to the dock without the water."
Build strong pelvic-floor muscles by doing Kegel exercises today and every day of your life, advises Dr. Thornton. Kegels (named after the doctor who invented the exercise) use the muscles that control urination. Kegel exercises can help strengthen the pelvic-floor muscles. To do them, urinate little by little. Contract and release your pelvic-floor muscles 10 times slowly. Once you understand the process, you can practice doing Kegels when you're not urinating. Try to work your way up to 300 Kegels a day.
"Every so often, contract the muscles as hard as you can and hold for for a count of five to ten seconds or as long as you can," says Dr. Thornton. "Repeat 100 to 200 times a day. You don't have to do them all at once. Break it up into 30 in the morning, another 30 midmorning and so on. The rule of thumb is to be repetitive throughout the day, while you're sitting in your car waiting for a stoplight or pushing papers on your desk."
No heavy lifting. Hoisting heavy loads--like a 25-pound toddler or bag of cat kitter--"may exceed the physiologic limits of the ligaments," tearing them and worsening prolapse, says Dr. Brubaker. "Occupational stresses, like carrying around heavy trays of food in a job as a waitress, exceed the limits."
When you must lift things, says Dr. Thornton, "at least do it the right way. Squat down and use the muscles of your legs, not your back or abdomen."
And if you've had surgery for prolapse, you must continue to swear off heavy lifting at least for a few months to give yourself time to heal, says Dr. Brubaker.
Live smoke-free. You wouldn't think that swearing off cigarettes would have anything to do with keeping your uterus in shape, but it does.
"Coughing from smoking increases interabdominal pressure," says Dr. Thornton. "So women who smoke tend to have an increased incidence of uterine prolapse," says Dr. Thornton. Conversely, quitting does your uterus a favor.
Use the missionary position. Many women with uterine prolapse don't feel as sexually desirable because they think that, during sex, their partner is going to feel their uterus in their vagina, says Dr. Brubaker. Relax. The forces of gravity pull your uterus down only when you're standing up, she says. When you lie down, it pretty much moves back to its original position.
"Most men can't detect that the uterus is in the wrong place," Dr. Brubaker says.
