Uterine Prolapse

Uterine Prolapse

Uterine Prolapse | Johns Hopkins Medicine

Linkedin Pinterest Gynecological Conditions Pelvic Floor Disorders What You Need to Know

  • When pelvic muscle, tissue and ligaments weaken, the uterus can drop down into the vaginal canal, causing uterine prolapse.
  • Nearly one-half of all women between ages 50 and 79 have some degree of uterine or vaginal vault prolapse, or some other form of pelvic organ prolapse.
  • Factors that increase your risk of uterine prolapse include childbirth, age, obesity, chronic constipation and having a hysterectomy.
  • Many women with uterine prolapse have no symptoms. If symptoms are present, they may include bulging in the vagina, feeling pressure in the pelvis or vagina, and lower back pain accompanied by bulging in the vagina.
  • There is no definitive way to prevent uterine prolapse. Losing weight, eating a fiber-rich diet, quitting smoking and performing pelvic floor exercises can help to reduce the risk of this condition.

Uterine prolapse occurs when the muscles and tissue in your pelvis weaken. The weakness lets the uterus drop down into your vagina.

Sometimes, it comes out through your vaginal opening. Nearly half of all women between ages 50 and 79 have this condition.

What causes uterine prolapse?

Uterine prolapse is caused when the muscles and tissue of the pelvic floor are weakened and can’t support the weight of the uterus. This lets it drop into your vagina.

What are the risk factors for uterine prolapse?

Risk factors include:

  • Giving birth (highest risk)
  • Vaginal delivery (vs. C-section)
  • Menopause
  • Being Caucasian
  • Being overweight
  • Smoking

What are the symptoms of uterine prolapse?

Many women with this condition have no symptoms. However, if symptoms start, they may include:

  • Leakage of urine
  • Inability to completely empty your bladder
  • Feeling of heaviness or fullness in your pelvis
  • Bulging in your vagina
  • Lower-back pain
  • Aching, or the feeling of pressure, in your lower abdomen or pelvis
  • Constipation

How is uterine prolapse diagnosed?

If your healthcare provider thinks that you have a prolapsed uterus, he or she will probably do a physical exam to check your pelvis. If you also have urinary incontinence or a feel you can’t empty your bladder, your doctor may do a procedure called a cystoscopy to examine your bladder and urethra.

Your healthcare provider might also order an MRI (magnetic resonance imaging). This procedure uses a magnet and radio waves to create images. This will allow your healthcare provider to get a good look at your kidneys and other pelvic organs.

If your symptoms bother you or you’re not comfortable during everyday activities, talk with your healthcare provider about treatment options. Lifestyle changes, such as losing weight, may help.

So can doing Kegel exercises. These strengthen your pelvic floor muscles. To do this exercise, you squeeze the muscles you use to control the flow of urine, and hold for up to 10 seconds then release.

Repeat 50 times a day.

A pessary can also relieve symptoms. This is a device your healthcare provider inserts into your vagina to support your pelvic organs.

A hysterectomy is a surgery to remove your uterus. This can be done through your vagina. The healing time is faster than with surgery that requires an abdominal incision. There also are fewer complications.

Can uterine prolapse be prevented?

There is no certain way to prevent uterine prolapse. However, the following can help lower your risk:

  • Lose weight, if you’re overweight
  • Follow a diet rich in fiber and fluids to prevent constipation and straining
  • Avoid heavy lifting
  • Quit smoking, if you smoke
  • Seek prompt treatment for a chronic cough, which can place extra pressure on your pelvic organs
  • Do Kegel exercises to strengthen your pelvic floor muscles

These actions may also help if you already have uterine prolapse.

See your healthcare provider when symptoms first start to bother you. Don’t wait until your discomfort becomes severe. Regular pelvic exams can help detect uterine prolapse in its early stages.

Key points for uterine prolapse

  • Uterine prolapse occurs when the muscles and tissue in your pelvis weaken.
  • This allows your uterus to drop down into your vagina.
  • Common symptoms include leakage of urine, fullness in your pelvis, bulging in your vagina, lower-back pain, and constipation.
  • Treatment for uterine prolapse includes lifestyle changes, a pessary, or surgery to remove the uterus.
  • You may be able to prevent this condition with weight loss, a high fiber diet, not smoking, and doing Kegel exercises.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down the questions you want to be answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also, write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also, know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Dr. Victoria Handa and her team at the Johns Hopkins Women's Center for Pelvic Health and Reconstructive Surgery study how childbirth leads to long-term physical and functional changes in a woman’s body. Watch to learn more.

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/uterine-prolapse

Delivery method associated with pelvic floor disorders after childbirth

Uterine Prolapse | Johns Hopkins Medicine

Vaginal childbirth substantially increases the probability a woman will develop a pelvic floor disorder later in life, a new study has found.

Pelvic floor disorders, including urinary incontinence and uterine prolapse, afflict millions of women in the U.S., and until now, little was known about who will develop these conditions and how they progress over time.

In this week's Journal of the American Medical Association, researchers from Johns Hopkins and the Greater Baltimore Medical Center report results of a 10-year study that show some delivery modes, including spontaneous vaginal delivery, are associated with higher risk of some types of pelvic floor disorders.

“We knew that these disorders are more common after childbirth, but now after following these women for 10 years, we have a good sense of how delivery mode impacts a woman's risk of developing a pelvic floor disorder,” says Victoria Handa, professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine and director of gynecology and obstetrics at Johns Hopkins Bayview Medical Center.

This study considered a woman's risk of developing one of four pelvic floor disorders: stress urinary incontinence, when urine leaks during activities that increase abdominal pressure; overactive bladder, marked by frequent and urgent urination; anal incontinence, which is the involuntary loss of solid stool, liquid stool, or gas; and pelvic organ prolapse, when the uterus and vaginal walls fall downward into the vagina, protruding beyond the vaginal opening when bearing down.

The research team enrolled 1,528 women within five to 10 years of their first birth. These women were followed annually for up to nine years.

Of the women, 778 delivered all of their children via cesarean birth, 565 had at least one spontaneous vaginal delivery and 185 had at least one delivery involving forceps or vacuum-assistance, also called operative vaginal delivery. The median age at enrollment was 38.

3—the youngest study participant at enrollment was 22.7 years old and the oldest participant at the end of the study was age 61.7.

The team collected information from the women at the time of enrollment, including date of first birth, age at first birth, body mass index, whether they had developed any pelvic floor disorder already, birth delivery mode, and genital hiatus size—the distance between the urethra and the posterior hymen.

The team then collected information at follow-up visits. The cesarean birth group made 4,039 visits, the spontaneous vaginal delivery group made 2,817 visits, and the operative vaginal delivery group made 948 visits.

Some women already had developed pelvic floor disorders at the time of study enrollment while others developed the conditions over the course of the study.

In all, the researchers found that cesarean delivery substantially reduced the risk of pelvic floor disorders, most notably pelvic organ prolapse, while operative delivery increased the risk. And for pelvic organ prolapse, the magnitude of these differences grew over time.

For example, by 15 years after a first delivery, prolapse of the uterus or vaginal wall beyond the vaginal opening was seen in 9 percent (7–12 percent) of women who had delivered by cesarean, 30 percent (25–35 percent) who had at least one vaginal delivery and 45 percent (37–53 percent) of those who had at least one operative delivery.

The researchers also found that a large percentage of new cases of urinary and bowel incontinence developed in the first five years after delivery, while pelvic organ prolapse tended to develop many more years after childbirth.

A third discovery was that the genital hiatus size is significantly associated with all pelvic floor disorders but most significantly with pelvic organ prolapse. This suggests that the genital hiatus size is a marker that might identify women at high risk of developing pelvic floor disorders with aging.

“While this study was limited to one community hospital and might not accurately reflect populations nation- or world-wide, it is the first time we have been able to gather data over a significant period of time,” says Handa.

“These data help us understand which women might be at highest risk to develop these conditions.

Ultimately this research will help us identify which women should be targeted for prevention strategies, and will hopefully improve our ability to deliver the right type of care to the right person.”

Posted in Health

obstetrics, pregnancy, maternal health

Source: https://hub.jhu.edu/2019/01/10/childbirth-method-pelvic-floor-disorder/

Delivery method associated with pelvic floor disorders after childbirth: Decade-long study identifies women at highest risk for incontinence

Uterine Prolapse | Johns Hopkins Medicine

Research completed at Johns Hopkins and the Greater Baltimore Medical Center has demonstrated that vaginal childbirth substantially increases the probability a woman will develop a pelvic floor disorder later in life. Pelvic floor disorders, including urinary incontinence and uterine prolapse, afflict millions of women in the United States.

However, until now little was known about who will develop these conditions and how they progress over time.

In this week's Journal of the American Medical Association, Johns Hopkins and Greater Baltimore Medical Center researchers report results of a 10-year study showing that some delivery modes, including spontaneous vaginal delivery, are associated with higher risk of some types of pelvic floor disorders.

“We knew that these disorders are more common after childbirth, but now after following these women for 10 years, we have a good sense of how delivery mode impacts a woman's risk of developing a pelvic floor disorder,” says Victoria Handa, M.D., M.H.S., professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine and director of gynecology and obstetrics at Johns Hopkins Bayview Medical Center.

This study considered a woman's risk of developing one of four pelvic floor disorders: stress urinary incontinence (urine leakage during with activities that increase abdominal pressure), overactive bladder (frequent and urgent urination), anal incontinence (involuntary loss of solid stool, liquid stool or gas) and pelvic organ prolapse (when the uterus and vaginal walls fall downward into the vagina, protruding beyond the vaginal opening when bearing down).

The research team enrolled 1,528 women within five to 10 years of their first birth. These women were followed annually for up to nine years.

Of the women, 778 delivered all of their children via cesarean birth, 565 had at least one spontaneous vaginal delivery and 185 had at least one delivery involving forceps or vacuum-assistance, also called operative vaginal delivery. The median age at enrollment was 38.

3 — the youngest study participant at enrollment was 22.7 years old and the oldest participant at the end of the study was age 61.7.

The team collected information from the women at the time of enrollment, including date of first birth, age at first birth, body mass index, whether they had developed any pelvic floor disorder already, birth delivery mode, and genital hiatus size — the distance between the urethra and the posterior hymen.

The team then collected information at follow-up visits — the cesarean birth group made 4,039 visits, the spontaneous vaginal delivery group made 2,817 visits and the operative vaginal delivery group made 948 visits.

Some women already had developed pelvic floor disorders at the time of study enrollment while others developed the conditions over the course of the study.

In all, the researchers found that cesarean delivery substantially reduced the risk of pelvic floor disorders, most notably pelvic organ prolapse, while operative delivery increased the risk. And for pelvic organ prolapse, the magnitude of these differences grew over time.

For example, by 15 years after a first delivery, prolapse of the uterus or vaginal wall beyond the vaginal opening was seen in 9 percent (7-12 percent) of women who had delivered by cesarean, 30 percent (25-35 percent) who had at least one vaginal delivery and 45 percent (37-53 percent) of those who had at least one operative delivery.

The researchers also found that a large percentage of new cases of urinary and bowel incontinence developed in the first five years after delivery, while pelvic organ prolapse tended to develop many more years after childbirth.

A third discovery was that the genital hiatus size is significantly associated with all pelvic floor disorders but most significantly with pelvic organ prolapse. This suggests that the genital hiatus size is a marker that might identify women at high risk of developing pelvic floor disorders with aging.

“While this study was limited to one community hospital and might not accurately reflect populations nation- or world-wide, it is the first time we have been able to gather data over a significant period of time,” says Handa.

“These data help us understand which women might be at highest risk to develop these conditions.

Ultimately this research will help us identify which women should be targeted for prevention strategies, and will hopefully improve our ability to deliver the right type of care to the right person.”

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Source: https://www.sciencedaily.com/releases/2018/12/181219093903.htm

Study advances research in pelvic organ prolapse among women

Uterine Prolapse | Johns Hopkins Medicine

By measuring the sagging of the vaginal walls in more than a thousand volunteers for up to nine years annually, a team of Baltimore physicians reports the creation of a long-awaited baseline measure of the rate of progression of so-called pelvic organ prolapse. The baseline, they say, should provide a foundation for reliable studies and a more rational search for factors that prevent or ease the condition.

“The good news is that pelvic organ prolapse progresses slowly,” says Victoria Handa, M.D., director of gynecology and obstetrics at Johns Hopkins Bayview Medical Center and first author of the study, which will appear in the March issue of the American Journal of Obstetrics and Gynecology.

“That means we have a lot of time to intervene before noticeable discomfort occurs, but more research is needed to allow doctors to accurately predict which women will develop severe prolapse and which will need surgical therapy.

We still don't know all the underlying causes nor what sort of interventions might work.”

Pelvic organ prolapse, Handa says, is an “understudied” condition in which a woman's vaginal walls naturally sag or droop with age and childbirth history, usually without symptoms at first.

Over time, however, it can progress to the extent that organ tissue puts pressure on or hangs the vaginal opening, creating an uncomfortable and embarrassing, though nonhazardous, situation.

Handa says that accurately estimating the number of women affected by moderate to severe prolapse is challenging, but she says prolapse is listed as the cause for 400,000 corrective surgeries every year in the U.S. Each operation costs an average of $9,035, according to data from a 2011 study.

In 1996, an international group of experts agreed on a simple system to approximate the extent of prolapse: Measure the distances from the vaginal opening to the front of the vagina (near the bladder), to the back wall of the vagina (near the rectum) and to the top of the vagina (near the uterus). The shorter the distances are, the less vaginal support there is.

“Unfortunately, not all gynecologists are trained to perform these measurements and they aren't part of routine checkups because we don't know how to use the information to benefit the patient yet,” says Handa.

To create a baseline guide, Handa and her colleagues used those three measurements to assess prolapse progression on an annual basis in 1,224 volunteers seen in Baltimore clinics who had had at least one child within the last five to 10 years. The women were followed for two to nine years.

While about 20 percent of the women studied saw no change in support or improved support, all other participants experienced a gradual worsening. The most rapid decline was seen in the front vaginal wall support, which sagged at a rate of 0.5 centimeters every five years, on average.

“This is reassuring,” says Handa. “Women who are told they have mild prolapse shouldn't start worrying or jump to the conclusion that they will need surgery. Vaginal support won't get worse quickly and it could even improve on its own.”

The study also revealed that women who gave birth vaginally were about five more years ahead in the progression of prolapse than those who delivered by Caesarean section.

Handa warns that this should not be used to encourage C-sections, but it is helpful in trying to better understand the risk factors for prolapse.

(Multiple vaginal deliveries have long been associated with increased risk of pelvic organ prolapse.)

Finally, the researchers found that the genital hiatus, which can also be measured at the time of vaginal examination, is associated with vaginal support.

The genital hiatus is an exterior measurement from the opening of the urethra—the tube that carries urine—to the base of the vaginal opening. It is wider in women who have had a vaginal birth, the study found.

That widening is independently associated with declining support inside the vagina and a faster rate of prolapse progression.

“That's a clue we're going to follow up on,” says Handa. “Whatever is affecting the size of the genital hiatus seems to also be affecting prolapse progression.”

In the next phase of its study, the team will assess 3-D ultrasounds of the pelvis, measures of pelvic muscle strength and other data collected from the same volunteers to examine the contributions of muscle structure and function. More information: Victoria L.

Handa et al, Longitudinal study of quantitative changes in pelvic organ support among parous women, American Journal of Obstetrics and Gynecology (2017). DOI: 10.1016/j.ajog.2017.12.

214 Journal information: American Journal of Obstetrics and Gynecology

Source: https://medicalxpress.com/news/2018-03-advances-pelvic-prolapse-women.html

Vaginal Prolapse

Uterine Prolapse | Johns Hopkins Medicine

Linkedin Pinterest Gynecological Conditions Pelvic Floor Disorders What You Need to Know

  • Vaginal prolapse, also known as vaginal vault prolapse, occurs when the top of the vagina weakens and collapses into the vaginal canal. In more serious cases of vaginal prolapse, the top of the vagina may bulge outside the vaginal opening.

     

  • Symptoms of vaginal prolapse include the feeling of vaginal pressure or fullness — you’re sitting on a small ball — and the sensation that something has fallen your vagina.
  • A cystocele or rectocele usually occurs with vaginal prolapse.
  • Mild cases of vaginal prolapse do not require treatment.

    Moderate to severe symptoms require nonsurgical therapies or minimally invasive surgeries, such as vaginal prolapse repair.

Prolapse occurs when a woman’s pelvic floor muscles, tissues and ligaments weaken and stretch. This can result in organs dropping their normal position.

Vaginal prolapse refers to when the top of the vagina — also called the vaginal vault — sags and falls into the vaginal canal. In severe cases, the vagina can protrude outside of the body.

What causes vaginal prolapse?

There are no direct causes of vaginal prolapse. However, women are at an increased risk of developing vaginal prolapse if they:

  • Delivered children vaginally, especially repeat deliveries
  • Are approaching or experiencing menopause
  • Have certain lifestyle factors, including being overweight
  • Were born with a rare condition, such as bladder exstrophy

Vaginal Prolapse After Hysterectomy

Hysterectomy, a surgery to remove a woman’s uterus, is sometimes performed to treat uterine prolapse. However, vaginal prolapse can occur after hysterectomy (regardless of the reason for hysterectomy). This is called “vaginal prolapse after hysterectomy.”

How common is vaginal prolapse?

Vaginal prolapse is relatively common. About one-third of women will experience some degree of prolapse during their lifetime. If you have more than one risk factor, your chances of developing vaginal prolapse increase.

Vaginal Pressure

Women with vaginal prolapse often report feeling pressure in the vaginal area, described as a throbbing pain in the vagina. Women also report:

  • Vaginal fullness (such as the feeling that something is stuck in the vagina)
  • The sensation that something is falling her vagina

Additional Vaginal Prolapse Symptoms

The pelvic organs are all supported by each other. When one organ prolapses, it can affect the functioning of other nearby organs. Thus, some women also experience:

  • Changes in bowel function, such as difficulty having a bowel movement
  • Changes in bladder function, such as inability to empty the bladder
  • Secondary prolapses, specifically rectocele prolapse (sagging of the connective tissue between the vagina and rectum) or cystocele prolapse (sagging of the connective tissue between the vagina and the bladder).
  • Pain or discomfort during sexual intercourse
  • Difficulty using tampons

Your doctor will review your medical and surgical history and complete a physical exam. Additional tests, such as ultrasound or MRI, are rarely needed. In some cases, your doctor may also recommended urodynamics testing, a group of tests that evaluate bladder function.

Treatment for vaginal prolapse varies, depending on the severity of the symptoms. Many cases will not require treatment. In mild cases, your physician may recommend pelvic floor exercises to strengthen the muscles.

In moderate cases, your doctor may insert a vaginal pessary to support your vaginal wall.

In the most severe cases, you may benefit from surgery, such as colposuspension, a minimally invasive surgical procedure, where the vaginal wall is attached to a stable ligament in the pelvis.

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/vaginal-prolapse