มดลูกหย่อน (Uterine Prolapse) อาการ สาเหตุ การตรวจวินิจฉัยและการรักษา

Uterine Prolapse

Uterine prolapse is a common condition as women age. When the muscles and tissues in the pelvis become weak after menopause or damaged due to multiple vaginal childbirths, the uterus can sag into

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Uterine Prolapse

Uterine prolapse is a common condition as women age. When the muscles and tissues in the pelvis become weak after menopause or damaged due to multiple vaginal childbirths, the uterus can sag into the vagina. The severity of the condition depends on how weakened the supporting muscles and ligaments around the uterus are. 

Stages of uterine prolapse

  • Stage I: The uterus is in the upper part of the vagina.
  • Stage II: The uterus descends to the lower part of the vagina. 
  • Stage III: The uterus protrudes out of the vagina.
  • Stage IV: The whole uterus is outside of the vagina.

It is possible for other organs in the pelvis to stretch out and prolapse, causing cystocele (prolapsed bladder), enterocele (prolapsed small intestine), and rectocele (bulging rectum).

Symptoms

In mild cases, the symptoms may not be obvious. Once the condition progresses, you can develop the following symptoms:

  • Pressure in the pelvis.
  • Pelvic, abdominal, and lower back pain. 
  • Painful intercourse.
  • Uterine tissue drops out of the vaginal opening.
  • Constipation.
  • Urinary incontinence and urinary frequency


When to see a doctor

If you feel something bulges or comes out of your vagina, urination or defecation becomes painful, or you experience chronic low back pain or pelvic pressure, consult your doctor for a proper diagnosis and treatment before other organs are affected.

Causes

When your pelvic floor muscles weaken, they cannot hold your uterus in place and prevent its sagging into the vagina. The causes of weak pelvic muscles are obesity, pregnancy, multiple vaginal childbirth, vaginal childbirth for babies weighing more than 4 kgs, chronic constipation or straining, chronic coughing, and repetitive heavy lifting. 

Risk factors

  • Multiple vaginal deliveries
  • Menopause. When your ovaries no longer produce estrogen that keeps your pelvic muscles strong, you are at higher risk of developing uterine prolapse. 
  • Pelvic surgeries
  • Family history of uterine prolapse


Diagnosis

  • Pelvic exam: to check the position of your uterus. The doctor will place a speculum to see inside your vagina. Your doctor will feel any bulges in your vaginal canal. You may be asked to cough or strain like you are holding your urine to evaluate the degree of your pelvic muscles weakness.


Treatment

Nonsurgical options

  • Kegel exercise to tighten your pelvic muscles. It is a recommended treatment for mild cases. Hold your pelvic muscles as if holding back urine for a few seconds and release. Repeat the exercise 10 times for four sets a day. 
  • Vaginal pessary. A soft, flexible, rubbery device will be placed into the vagina to hold your uterus in place. 
  • Diet and lifestyle modification. Keeping a healthy weight can prevent pressure on your pelvis. Consuming more fluids and fiber can relieve constipation and reduce straining. 

    Surgical options

    • Hysterectomy. Your doctor may recommend a vaginal or abdominal hysterectomy to remove your uterus if you no longer want to get pregnant.  
    • Prolapse repair. Uterine suspension through abdominal or vaginal approach to reattach your pelvic floor muscles to hold your uterus in place. 

    Uterine prolapse treatments are usually effective and satisfactory, but a recurrence can happen, especially when the condition is severe, you are younger than 60, and being overweight.

    Prevention

    • Keep a healthy weight, as extra weight can stretch your pelvic floor muscles.
    • Exercise and do Kegel exercise regularly.
    • Practice proper lifting techniques for heavy objects
    • Quit smoking. A chronic cough can put pressure on your pelvic muscles.
    • Do not strain when pooping, and avoid constipation.

    Proper lifting techniques to prevent uterine prolapse

    • Do not lift heavy objects alone or above your waist level. 
    • Stand firm with a wide stance. Keep your back straight. Bend your knees and hips to lift the object. Never bend forward with your waist.
    • Tighten your abdomen and lift with your lower body. Stand upright with no twisting. 
    • If you want to put down the object, stand firm with a wide leg stance, contract your stomach muscles, and slowly bend your hips and knees.





    Article by
    Dr Sarwinee Ratchanon

    An obstetrician specializing in reproductive endocrinology
    Doctor profile



    Published: 25 Apr 2023

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