What is uterine prolapse? What are its causes?

The organ in which the fertilised egg (the embryo) settles, grows and develops until the time of birth is called the uterus. The uterus is inside the pelvis, behind the bladder and in front of the large bowel. While the size of the uterus is between 5 and 6 cm in women who have not given birth, it is larger in women who have given birth (6-7 cm in size). The ligaments that hold the organs of the genital area in place can lose their function for reasons such as advancing age and the number and form of births. In this case the uterus slides downwards or comes out of the vagina. A large number of pregnancies, a lack of oestrogen, normal birth, giving birth to a large baby, lifting heavy loads, coughing constantly, chronic constipation and excessive straining, obesity, and the muscles and connective tissue around the abdomen being overstretched because of certain lung diseases also cause uterine prolapse. Uterine prolapse is seen more frequently in women in the post-menopausal period who have had one or more normal (vaginal) births. However, it can also be seen in women of reproductive age. Having genetically weak connective tissue is also one of the risk factors. A moderate degree of uterine prolapse involves symptoms such as lower back pain, something coming out from inside the vagina in the form of a mass, a feeling of heaviness around the lower abdomen or a feeling of being pulled downwards, and feeling pain during sexual intercourse. In mild and moderate degrees of uterine prolapse, Kegel exercises, which tighten the pelvic muscles, can ease the symptoms of the condition and give the patient relief. Kegel exercises, done as a precaution, are performed by tightening the pelvic floor muscles that support the uterus, the bladder and the bowel. The pelvic floor muscles are the muscles that are tightened to stop urine. If the pelvic floor becomes stronger, the symptoms related to uterine prolapse decrease and it provides better support for the organs inside the pelvis. In the Kegel exercises the pelvic muscles are tightened for 5 seconds and released for 5 seconds. These exercises should be done 3 sets of 10 times a day. However, an advanced degree of uterine prolapse requires surgery. The operation can be performed through the abdomen or from below (the vaginal route). In advanced degrees of prolapse the woman reaches a state in which she can feel her uterus with her hand. Or, in more advanced situations, when looked at from the outside the uterus can be seen completely outside the vagina. Uterine prolapse also affects the large bowel (rectum-rectocele) and the bladder (bladder-cystocele) located right beside it. When standing, while straining, and when coughing and sneezing, a feeling of fullness and pain is felt in the lower area. In those who experience prolapse of the rectum (the end of the large bowel) along with the uterus, the rectum comes very close to the vagina and causes constipation. If there is prolapse of the bladder, the problem of urinary incontinence and difficulty passing urine arises when standing, during sexual intercourse and while laughing. The prolapse of the organs of the genital area also affects sexual life negatively. When a doctor is consulted with complaints such as urinary incontinence and a feeling of fullness in the lower area, it can easily be detected as a result of a gynaecological examination. The treatment for uterine prolapse is planned according to the person. The patient’s age, whether or not she wants to have children, the degree of the condition and her general state of health change the form of the treatment. In mild and moderate degrees of prolapse, the prolapse can be stopped, at least partly, with Kegel exercises. In the case of advanced uterine prolapse a surgical operation is unavoidable. If the uterine prolapse is of an advanced degree, the ligaments that hold the uterus in place inside the abdomen are reached and these ligaments are pulled up and strengthened. In this way there is no need for the uterus to be removed either. The risk of the prolapse appearing again varies according to the type of operation performed and according to how the patient protects herself after the operation. To prevent the problem of uterine prolapse from arising, eating healthily, not gaining excessive weight and not becoming constipated are at the head of the precautions to be taken. Doing exercise to strengthen the muscles at the base of the abdomen will also be beneficial.