The uterus is held in position above the vagina by ligaments and tendons. The pelvic floor muscles also contribute to this. Natural ageing processes, but also childbirth, can reduce the elasticity of the holding apparatus. The uterus can then shift downwards due to gravity. This process is known as uterine prolapse or, in medical terms, descensus uteri.
Below you will find further information and selected specialists for uterine prolapse.
The uterus is elastically attached to the pelvic wall by ligaments(ligg. rotunda, ligg. cardinalia). It is supported from below by the sacrouterine ligaments and the pelvic floor. The pelvic floor consists of several layers of muscles and connective tissue. They are attached to the bones of the pelvis like a kind of "hammock".
The urethra, vagina and rectum pass through a natural opening in the pelvic floor. The uterus can also descend through this gap if it is no longer held properly.
Illustration of the descending uterus and surrounding organs © Henrie / Fotolia
The reason for uterine prolapse is usually a weakening of the pelvic floor structures. There can be various causes for this. A combination of several risk factors in particular can cause the uterus to descend. Risk factors include, for example
A typical symptom of uterine prolapse is a feeling of downward pressure. A foreign body sensation in the vagina is also a common symptom of uterine prolapse. Some women suffer from pulling pain in the lower abdomen that radiates to the back after physical exertion.
These symptoms are caused by the uterus pulling on the ligaments from which it is suspended. The symptoms are usually less severe in the morning and increase over the course of the day.
If the pelvic floor is overstretched, the urethra is often no longer firmly attached to the tissue. Around half of those affected experience involuntary loss of urine during physical activity(stress incontinence). However, bladder emptying disorders with incomplete bladder emptying can also occur. The urine remaining in the bladder (residual urine) favors the development of bladder infections.
In severe cases, the rectum protrudes into the vagina. This can lead to difficulties with defecation.
If the vaginal mucosa or the cervix comes down, this can lead to pressure sores on the skin. These sometimes cause bleeding or colonization of the mucous membrane with bacteria and fungi. This in turn can lead to discharge and odor.
Medically, there are four degrees of severity of uterine prolapse:
Be sure to see a gynecologist if you experience the symptoms described.
Basic diagnostics include a gynecological speculum and palpation examination. This allows the doctor to assess the position of the genital organs at rest and when pushing. In addition, he checks the function of thesphincter muscle(sphincter ani) when squeezing.
By means of a cough test with a full bladder, the doctor can clinically confirm a loosening of the urethra with stress incontinence.
Further examination options:
Not every uterine prolapse leads to symptoms in the affected women. However, if symptoms do occur, the uterine prolapse should be treated.
In principle, treatment initially involves conservative, non-surgical measures . Surgery may only be necessary if these do not bring any improvement.
These measures include, for example
If the symptoms do not improve with conservative measures, surgery is necessary. The choice of surgical procedure depends on several factors:
Surgery can be performed from the vagina, via an abdominal incision or with laparoscopy. The following surgical measures are possible:
Removal of the uterus(hysterectomy): Removal of the descended uterus through the vagina (vaginally), via laparoscopy or abdominal incision.
Fixation of the end of the vagina: The end of the vagina can be attached to connective tissue (retaining ligaments) in the area of the removed uterus or to a ligament in front of the spine(longitudinal ligament).
Plastic mesh is usually used for this. However, as there have been repeated complications with this, tendon tissue from the thigh has recently also been used.
Narrowing of the vagina (vaginoplasty): Tightening of the sagging vaginal wall at the front and back. However, as the vagina is very stretchy, success is usually short-lived. In almost 30 percent of cases, a new prolapse occurs after 5 years at the latest.
Insertion of a plastic mesh under the vaginal skin (mesh insertion): This method results in a more stable vaginal correction. A plastic mesh is used to reinforce the vaginal walls. At the same time, the surgeon fixes the end of the vagina to the sacrospinal or sacrotuberous ligaments.
However, pain may occur after the operation. Under certain circumstances, the plastic mesh may protrude through the vaginal wall. As the vagina grows into the mesh, complete removal of the mesh is then no longer possible. Accordingly, such mesh should only be used in exceptional cases (for example, if other procedures have not been successful). In some countries, such as the USA, the use of plastic mesh is now banned.
Correction of stress incontinence: Existing incontinence can also improve after a prolapse operation. However, if the incontinence persists after the operation, it can be corrected in another operation.
The pelvic floor loses stability over the course of a lifetime. The best prevention is not to overload the pelvic floor and to exercise it regularly(pelvic floor training).
A prolapse of the pelvic floor can occur again even after surgical correction. For this reason, affected women should also think about prevention after an operation.
For women who are over 35 years old when they give birth to their first child, a planned caesarean section may be recommended. This protects the pelvic floor tissue.
After a birth, it is important to treat birth injuries and especially injuries to thesphincter muscle (Musculus sphincter ani). Postpartum and postnatal exercises help to strengthen the core of the body. Ideally, these exercises should continue to be performed regularly after childbirth.
As a preventative measure, care should be taken to maintain a normal weight and exercise sensibly. Sports that are useful for strengthening the pelvic floor are
Less favorable are sports with abrupt movements such as
The Leading Medicine Guide's quality assurance is ensured by the following acceptance prerequisites.
