The uterus is one of the main female reproductive organs. It is located in the pelvis and is held in position by several muscles, ligaments, and tissues.
Uterine prolapse or prolapsed uterus is a condition in which the pelvic muscles and ligaments holding the uterus become weak or stretch out and are unable to support the uterus. As a result, the uterus now starts to sag into the vagina. In case of complete prolapse, the uterus may begin to protrude outside the vagina.
A partially prolapsed uterus is a common condition, and almost 50% of women over the age of 50, experience some level of uterine prolapse. Once your doctor diagnoses uterine prolapse, he or she may use the Pelvic Organ Prolapse Quantification (POP-Q) system score to determine the degree of prolapse. This helps in determining the treatment protocol to be followed.
Symptoms of Prolapsed Uterus
Most women who experience a mild degree of uterine prolapse do not experience any symptoms. As the severity of the condition increases, women may experience one or more of the following symptoms –
- Pressure or pain in the pelvic area
- Unusual vaginal discharge or bleeding
- Heaviness in the pelvis
- Pain during sexual intercourse
- Chronic constipation
- Urinary incontinence or increase in frequency
- Difficulty in emptying the bladder
- Frequent bladder infections
- Uterus protruding out of the vagina
- Lower back pain
In most cases, the symptoms become more pronounced as the degree of prolapse increases.
Causes and Risk Factors
Uterine prolapse occurs when the muscles and connective tissues of the pelvis weaken and are unable to support the uterus in place. There are several causes for such weakness. These include –
- Prolonged or difficult labour
- Tearing or trauma during childbirth
- Chronic constipation and straining to move bowels
- Chronic cough
- Being overweight or obese
- Low oestrogen levels
- Weakening muscles due to ageing
- High-impact exercise
- Regular lifting of heavy objects
The risk of developing a prolapsed uterus increases with –
- Number of pregnancies and vaginal deliveries
- Increase in age
- Obesity and increase in weight
- Chronic constipation
- Pelvic surgery
How to exercise pelvic floor muscles?
In mild to moderate uterine prolapse cases, your doctor at Max Hospital may recommend pelvic floor exercises. Regular exercises to strengthen the pelvic floor and muscles help improve uterine prolapse symptoms. In some cases, the uterus moves back into its original position with the strengthening of muscles. In some cases, regular exercises keep the prolapsed uterus from an increase in severity. Unfortunately, in a small number of patients, surgical rectification becomes necessary.
Kegel exercises are known to strengthen the pelvic floor and prevent the prolapse of organs such as the uterus, bladder, and rectum.
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What you need to know about doing Kegels
While Kegels or Kegel exercises are a great way to strengthen the pelvic floor, it is important to understand how to do them and what to expect.
Pelvic floor muscles are the muscles that are nested inside your pelvic cavity and hold internal organs such as the uterus, bladder, and small intestine in place. This makes it difficult to identify the muscles and exercise them, unlike the muscles of the hands and legs.
Kegel exercises get easier with practice, and the results are worth the effort. The greatest advantage is that Kegel exercises can be performed at any time of the day, unlike most other exercises.
How to do Kegels
- To do the Kegels, you will first need to find the pelvic floor muscles. The easiest way to do this is to stop urinating midstream. The muscles that are now tightened are the pelvic floor muscles.
- Kegel exercises can be done in any position, but most women find it easier to do them lying down.
- An easy way to do Kegels is to imagine you are sitting on a marble and then try to lift the marble by tightening the pelvic muscles. Hold the tightened muscles for a count of three, and then relax for a further count of three.
- It is important to remember that while you do Kegels, do not tighten or squeeze your abdomen, thigh, or buttock muscles.
- Do not hold your breath. Breathe normally during these exercises.
- There may be some urinary incontinence as you exercise your pelvic floor muscles. It is best to empty your bladder before you start Kegels.
- Do your Kegels in sets of 10-15 at least three times a day for best benefits.
- Prolapsed uterus exercises and Kegels must be part of your daily routine. The benefits of these exercises can be seen as reduced pain and pressure in the abdomen, less urinary incontinence etc. It may take from a few weeks to months to experience the full benefits of Kegel exercises.
Exercises to avoid when you have a prolapsed uterus
If you have been diagnosed with a prolapsed uterus, it is best to consult your doctor or physical therapist about safe exercises.
Heavy lifting, abdominal crunches, planks, and deep squats are best avoided. These exercises put a lot of pressure on the abdomen and cause the pelvic muscles to stretch out more.
Running, jumping, and other high impact activities are also best avoided as they may exacerbate the condition. In addition, any activity or exercise that increases abdominal pressure, pushes down or bears down on the pelvis or causes you to hold your breath could worsen your symptoms from a prolapsed uterus.
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Pelvic Floor Muscle Training (PFMT) is a specialised branch of physical therapy that is offered to women diagnosed with uterine prolapse. Along with pessary support, it is the main form of non-surgical management of the condition.
Working with a physical therapist who specialises in prolapsed uterus exercises, Kegels, and PFMT offers you the best chances of finding relief from the symptoms of this condition. This is because a number of exercises and activities that we perform put undue pressure on the abdomen, worsening the condition. Physical therapists help identify the pelvic floor muscles and exercise them without worsening the prolapse.
Other Treatment Options
Pessary support:A vaginal pessary is a soft device inserted into the vagina by the doctor. It offers support to the organs affected by pelvic organ prolapse, such as the uterus. Your doctor may recommend a pessary in the form of a Ring, Gehrung (U shaped), Gellhorn (Disc with a hard centre), or Cube, depending on the severity of your condition. You will need to visit your doctor to find out the right size and shape of pessary. You will also need to learn to clean and care for it.
IVVS and IVES – Intravaginal vibratory stimulus (IVVS) and/or intravaginal electrical stimulation (IVES) are often recommended when women are diagnosed with uterine prolapse but cannot voluntarily contract the pelvic floor muscles to exercise them. Recent studies indicate that while both methods are effective, the IVVS is significantly more beneficial to the IVES in improving pelvic floor muscle strength.
Surgical treatment options:Prolapse repair may be done with or without hysterectomy. In some cases, hysterectomy or removal of the uterus is performed. This is major surgery and is recommended for women past childbearing age.
Uterine prolapse repair without hysterectomy involves placing the uterus back in its normal position and reattaching the pelvic ligaments for support. Surgical treatment is often recommended in case of severe uterine prolapse and in cases where pessary support and prolapsed uterus exercises fail to improve the symptoms.
Uterine prolapse is a painful condition that affects sexual function, social involvement, work, self-image, and activity levels. While it is not a life-threatening condition, it adversely affects the patient’s quality of life. Therefore, if you experience any prolapsed uterus symptoms for more than a few days, it is important to seek medical attention and treatment at the earliest. Kegels and pelvic muscle strengthening exercises help relieve the symptoms and even reverse the condition in some cases. This is only possible in case of mild to moderate prolapse, though. Severe cases may be treated through surgical intervention.