Uterine Prolapse and Urinary Incontinence

The uterus is the organ in which the fertilized egg (embryo) implants, grows and develops until the time of birth. The uterus, which has a dark pink color, is located in the pelvis, behind the bladder and in front of the large intestine.

In women who have not given birth, the size of the uterus is between 5-6 cm, while in women who have given birth, it is 6-7 cm. The ligaments that hold the organs of the genital area in place can lose their function due to advancing age, number and type of deliveries. The loss of this support causes the uterus to slide downwards or come out of the vagina. A large number of pregnancies, estrogen deficiency, normal vaginal delivery, giving birth to a large baby, lifting heavy loads, constant coughing, obesity, some lung diseases, chronic constipation and pushing too much also causes uterine prolapse.

Uterine prolapse is often seen in the postmenopausal period and in women who have had one or more vaginal deliveries. Having genetically weak connective tissue is also one of the risk factors.

A moderate uterine prolapse has symptoms such as lower back pain, feeling like there's something coming out of the vagina, feeling of fullness or pulling in pelvis or vagina, pain during sexual intercourse.

Kegel exercises that strengthen pelvic muscles can relieve the symptoms of the disease in mild or moderate cases.

However, in advanced cases surgical intervention is required. The surgery can be performed through the abdominal or vaginal route.

Kegel Exercises are performed as a precaution by contracting the pelvic floor muscles that support the uterus, bladder and intestines. Pelvic floor muscles are the muscle group that are contracted to stop urination. If the pelvic floor becomes stronger, it provides better support to the organs in the pelvis and the symptoms related to uterine prolapse decrease. In Kegel exercises, the pelvic muscles are squeezed for 5 seconds and then released for 5 seconds. These exercises should be repeated 10 times and at least 3 times a day.

In advanced prolapse, women can feel the uterus with their hands. In more advanced cases, the uterus may completely protrude out of the vagina. Uterine prolapse also affects the large intestine and urinary bladder which are adjacent to it. Fullness and pain are felt in vagina and pelvis, while standing on feet, pushing, coughing and sneezing. If the rectum (the ending of the large intestine) prolapses along with the uterus, the rectum moves closer to the vagina and this causes constipation. If the bladder is prolapsed, urinary incontinence while standing, lauging and during sexual intercourse and difficult urination occur. Prolapsed genital organs also negatively affect sexual life. When a doctor is consulted with complaints such as urinary incontinence and fullness in the vulvar region, it can be easily diagnosed with a proper gynecological examination.

Treatment for uterine prolapse is planned individually. The severity of the disease, the patient's age, health status and desire to have children affect the treatment choice. In mild to moderate sagging, Kegel exercises can partially stop the sagging. However, surgical operation is inevitable in advanced cases. Women who undergo vaginal tightening surgery are recommended to give birth by cesarean section if they become pregnant again.

If the uterine prolapse is severe, the ligaments in the abdomen that hold the uterus in place are reached, pulled up and strengthened. That surgical intervention provides a solution without removal of the uterus. However, the results obtained with suspension operations may not be very long-lasting. There is a risk that the prolapse may reappear. In order to prevent the problem of uterine prolapse, eating a healthy diet and not gaining excess weight are the most important measures to be taken. Exercises to strengthen the muscles at the base of the abdomen will also help.

Urinary incontinence, which occurs due to reasons such as advanced age, having many deliveries and being overweight, can be a disease itself or a symptom of an important disease. This problem is more common in women than in men and increases with advancing age.

Urinary incontinence, which is seen in situations such as heavy lifting, sneezing and climbing stairs, affects quality of life negatively. Some patients do not experience urinary incontinence while performing their daily activities, however they may have problems such as frequent urination or sudden urges to urinate and inability to reach the toilet. This problem keeps women who urinate 10-15 times a day and more importantly, who also leak urine, away from social life.

Difficult and traumatic deliveries increase the risk of urinary incontinence, while cesarean and normal vaginal births have no significant effect on this problem. However, having a lot of deliveries, assisted deliveries and prolonged labor can invite urinary incontinence.

Being overweight is one of the leading factors causing urinary incontinence. Because the increase in intra abdominal pressure with excess weight puts the urinary tract at risk. Regular pelvic floor exercises to strengthen the muscles can be helpful in this regard. Strengthening the muscles has positive effects on the urinary continence.

We have said that this problem is more common in women, but this does not mean that men do not have urinary incontinence. Stress urinary incontinence in men is mostly seen after prostate surgery or pelvic fractures.

The problem of urinary incontinence, especially in the older age group, should be treated and the patient's lost quality of life should be regained. Surgical treatments are performed for urinary incontinence, especially for the type which occurs due to weak support to the bladder neck. One of these applications is 'sling surgery'. The duration of these operations do not exceed 10-15 minutes. The patient can be discharged on the same day. Suspension surgeries are not performed on every patient; the appropriate patient selection and existence of an experienced physician determine the success of the treatment.