uterine prolapse

Uterine depression: description

Decreasing the uterus (uterine uterus) is a downward movement of the uterus, ie the uterus “hangs” deeper in the pelvis than usual. In extreme cases, the uterus even partially or completely through the vagina to the outside. Physicians then speak of a uterine prolapse (uterine prolapse). In mild cases, lowering the uterus may be asymptomatic. Usually, however, there are various complaints.

Normally, the uterus is held in place by several retaining structures. These include ligaments (ligaments), connective tissue and the pelvic floor muscles. However, these support structures can weaken and the uterus no longer stabilize sufficiently. In the entire pelvic floor there is a general reduction: uterus, urinary bladder or rectum may slip downwards.

Overall, between 30 and 50 percent of all women get a pelvic floor reduction during their lifetime. But symptoms do not necessarily have to happen with every woman. Many women have no symptoms with a slight uterine erosion, so that the uterine reduction is medically often not relevant. Treatment is only necessary if the uterus is more severe with noticeable symptoms or impaired function and, of course, if the uterus proliferates.

Lowering the uterus may also affect younger women. This is especially the case when there is a chronic weakening of the connective tissue.

Divorce and vaginal discharge

In addition to the uterine depression, there is also the vaginal depression (Descensus vaginae). Here, the vagina sags down. If parts are hanging out of the vagina, it is called a vaginal prolapse (prolapse vaginae or vaginal prolapse). Often, a vaginal depression or vaginal discharge occurs along with uterine erosion. Typical of a vaginal depression is a foreign body sensation in the vagina, along with problems with urinary retention.

Uterine depression: symptoms

Uterine reduction can be felt in several ways. Classic uterine depression symptoms include abdominal or back pain. However, such pains are less specific and are usually attributed to other causes by affected women.

Lowering the uterus in most women causes a chronic sensation of pressure or foreign body in the vagina, as well as a steady downward pull. This creates the fear that something might “fall out” of the vagina. Affected women often cross their legs. In addition, there is increased inflammation and mucosal deposits, as the vaginal flora is changed. Also, pressure ulcers occur. Another symptom is bloody discharge from the vagina.

Because the uterus is in close proximity to the urinary bladder, it can put pressure on it as its position changes. Typical symptoms include pain when urinating, a weakened stream of urine and frequent urination with small amounts of urine (pollakisuria). In some cases, so-called stress incontinence also occurs. For example, if coughing or sneezing, unintentional urine is lost. Also urinary tract infections can accumulate. In extreme cases, there may be a shift or a decrease in the bladder. As a result, the urine backs up in the kidney. This complication is rare.

To the rear, near the uterus, are the rectum and the anal canal. If the uterus slides down and behind, it can also exert pressure on the rectum. Consequences are constipation and / or pain during bowel movements. Fecal incontinence also occurs occasionally.

If a uterine depression goes unnoticed for a long time, it exerts increasing pressure on the pelvic floor. In extreme cases, the uterus can emerge completely or partially from the vagina. Physicians then speak of a uterine prolapse or uterine prolapse. Symptoms are obvious here: The uterus can be seen visually from the outside.

Uterine ulcer: causes and risk factors

A reduction of the uterus occurs when the ligaments and muscles that normally guarantee the stability of the pelvis are no longer sufficiently strong. The uterus then sinks according to the downward force of gravity. In the course of life, various factors can help to overburden the support structures. This includes:

• Over- and underload of the pelvic floor due to heavy physical work
• Pressure increase in the abdominal cavity due to diseases such as chronic bronchitis or chronic constipation
• obesity
• general connective tissue weakness

In addition, it may come from birth to a different location of the uterus location. Even with such positional anomalies, the risk of uterine prolapse is increased. Here are often already from the age of 30 first symptoms.

Uterine ulcer after birth

Even after birth, the likelihood of uterine erosion is increased. If the fetuses are heavy, the ligaments in the pelvic area are heavily loaded. Vaginal injuries at birth also pose a potential risk. Women who have had multiple children throughout their lives, therefore, firstly suffer more often and, secondly, sooner from a uterine prolapse.

In addition, a vaginal delivery may result in a transient uterine prolapse. In most cases, this will return by itself within a few days. If this is not the case, a treatment is needed here as well. An episiotomy reduces the risk of uterine erosion, as the targeted incision avoids excessive pressure and tearing of the tissue.

Uterine ulcer: examinations and diagnosis

In case of a suspected uterine prolapse, the gynecologist is the right person to contact. In a first conversation the medical history (anamnesis) is recorded. You have the opportunity to describe your symptoms. Based on the classic complaints, there is usually a relatively quick suspicion of a uterine depression.

During the gynecological examination, a clear diagnosis can then be made. Using a speculum (vaginal level), the doctor examines the vagina and can detect a uterine depression.

Also, a rectal examination is one of the suspected uterine sinking. The doctor scans directly into the rectum. For example, he can feel an invagination of the wall of the rectum (rectocele) towards the vagina. Such a bulge is a common cause of constipation.

To assess the extent to which the bladder is affected by uterine erosion, an ultrasound scan is performed. Thus, possible consequences of uterine erosion can be better determined. If there is a suspicion of a urethral infection, a urine sample is taken and examined in the laboratory.

Uterine ulcer: treatment

Depending on the stage in which the uterine cavity is detected and the age at which the person is affected, different methods of treatment may be considered. Basically, a therapy is necessary if the uterine depression causes discomfort. The way then depends on whether the patient still wants children.

In light forms and also for prevention, for example during pregnancy, helps pelvic floor exercises. These are special exercises that specifically strengthen the muscles of the pelvic floor. Thus, a lowering of the pelvic organs can be prevented. Light forms of subsidence can thus also independently, that is, without special medical interventions, regress.

In addition, for women with mild uterine erosion, who are already in menopause, a hormonal treatment may be useful. For this purpose, suppositories or creams are used to apply female sex hormones (estrogens). A vaginal ring that consistently releases low levels of estrogen may also help in the treatment of uterine erosion.

Uterine sinking: surgery

In more severe cases, surgery is inevitable. In principle, two methods are considered for the operation. In the best case, the doctor can make the procedure by the vagina alone. Sometimes, however, it is necessary to make a cut of about five centimeters on the lower abdomen through which the operation takes place.

During the operation, the pelvic muscles are ruffled and organs that have been lowered are returned to their original position. To gather the pelvic floor muscles and to reinforce the dam, the so-called vaginal plastic is used. Physicians distinguish between a front and a back vagina plastic. The anterior vaginal surgery is used in a bladder and vaginal depression. The bubble bottom is gathered and the neck of the bladder is raised. In the posterior vaginal surgery, the vaginal skin is detached from the rectum, the excess stretched vaginal skin removed and re-sutured after sewing up the bladder or the rectum.

If there is no longer a wish for a child, the uterus is usually removed during the operation (hysterectomy). To prevent an incident of the remaining vaginal blinding sac, it is fixed in the pelvic cavity using a special tissue strip (vaginosacropexy).

If there is an incontinence (uncontrollable loss of urine) during uterine prolapse, there are a number of other surgical procedures (for example, elevation of the vaginal wall and correction of urethral bladder neck angle (colposuspension).

Transvaginal mesh (TVM) is another way to treat uterine prolapse. In doing so, the doctor inserts a mesh between the bladder and the pelvic floor in an operation over the vagina.

Operation follow-up

The surgery takes about 30 to 60 minutes and is usually under general anesthesia. Some hospitals and medical care centers also offer treatment under local anesthesia. After the operation, a hospital stay of about two days is necessary. Complications are very rare during surgery. In most cases, operated women can return to their normal work after only a few days.

As a consequence of problems with uterine erosion surgery, especially difficult urination and problems and pain during sexual intercourse are considered. These problems can be caused by overcorrection. Bleeding or infection is very rare compared to other surgeries.

pessary

For older and physically very weak women, surgery is out of the question. Here, the treatment is usually gentle by means of so-called pessaries. A pessary is bowl, dice or ring shaped and is made of hard rubber or silicone. A pessary is inserted into the vagina by the doctor and supports the uterus. It is important that a pessary does not correct an existing reduction, but merely counteracts a further reduction. A pessary must be regularly cleaned and reloaded so that it does not cause inflammation. Basically, it can only be used to treat uterine erosion if the perineal musculature is still sufficiently strong.

Uterine ulcer: disease course and prognosis

Lowering the uterus is not an independent disease, but a symptom of a weakening pelvic floor. For this reason, a uterine depression can only be treated symptomatically. A causal treatment is not possible. Due to the weakness of the pelvic floor, it can always lead to incidents. Preventative measures can reduce the risk of another incident.

There are several ways to prevent a uterine prolapse. The most important is the pelvic floor exercise. These are special gymnastic exercises that specifically strengthen the holding muscles. There are also special exercises after birth to either help reduce uterine erosion or to help stabilize the pelvic floor.

Another measure is to avoid excessive physical stress such as lifting heavy loads. If lifting is unavoidable, then care should be taken not to lift out of bent posture, but to crouch down. Regular exercise also prevents uterine erosion. Endurance sports such as swimming, cycling or running have proved particularly helpful. For overweight women, it is also recommended to reduce body weight.

All of these measures can be taken both before and after a uterine prolapse or uterine prolapse surgery. A method to a uterine prolapse However, there is no such thing as preventing it. All preventive measures can only reduce the individual risk.