After giving birth, the uterus prolapsed and fell onto the thigh. This is not a horror movie, but a documentary of countless women.

A 32-year-old mother of two in Zhengzhou, Henan Province, was bedridden for eight months after giving birth. The reason was terrifying: as soon as she stood up, her uterus would fall out of her vagina and onto her thighs!

Uterine prolapse literally means that the uterus has moved out of its normal anatomical position and is displaced downward to the vaginal wall. In severe cases, it may even fall out of the vaginal opening. Uterine prolapse is a type of pelvic organ prolapse (POP). A more professional explanation is that the pelvic organs herniate to or beyond the vaginal wall .

Pelvic organ prolapse may not be limited to the uterus, because the pelvic organs are mostly continuous, and prolapse of one part is often accompanied by prolapse of another part. For example, prolapse of the anterior vaginal wall is often accompanied by descent/protrusion of the bladder, and prolapse of the posterior vaginal wall is often accompanied by descent/protrusion of the rectum.

A: CystoceleB: RectoceleC: Enterocele

Do you think this is scary enough? Here is another ghost story:

The prevalence of pelvic organ prolapse (POP) is not low!

In a cross-sectional study, researchers interviewed 1,961 women aged 20 to 80 and asked them whether they had experienced bulging in the vaginal area or anything that could be seen or felt falling out. The prevalence of symptomatic POP was 2.9% .

Data from international urogynecology show that the prevalence of POP varies greatly worldwide, with the prevalence of POP estimated from symptom reports and pelvic examinations ranging from approximately 20% to 65% ;

Data from UpToDate Clinical Advisor indicate that the lifetime risk of a woman undergoing surgical prolapse repair is 11%-19% .

Of course, these are conservative estimates. It is difficult to determine how many women actually suffer from pelvic organ prolapse , because some women do not seek medical treatment because their symptoms are mild, and some women refuse to seek medical treatment because they do not care or find it difficult to talk about it.

Weibo user comments

The ghost stories in horror movies are actually the realities experienced by countless women. The purpose of writing this article is definitely not to cause anxiety or make people afraid of having children. After all, whether you say it or not, the incidence of pelvic organ prolapse is there.

Instead, I want everyone to have a correct understanding of the disease of pelvic organ prolapse. If it happens to you, please do not be like the mother in the news who stayed in bed for eight months and only sought diagnosis and treatment when she could not bear it anymore . If there are elderly relatives in your family who are suffering from this problem, please tell them that in addition to enduring and fighting hard, there are many modern medical options available.

Why does the uterus prolapse?

The support of female pelvic organs is provided by the interaction of the pelvis, pelvic floor muscles, connective tissue ligaments and fascia. Pregnancy and childbirth can cause compression, stretching and tearing of nerves, muscles and connective tissues, causing pelvic floor damage and weakening the pelvic support structure. In short, it can no longer hold the pelvis.

Schematic diagram of the female pelvic cross-section. Source: UpToDate

Multiple pregnancies are a risk factor for POP . 75% of prolapse in multiparous women can be attributed to pregnancy and childbirth. The more parities there are, the greater the risk. An Oxford study showed that mothers who gave birth to one child had a four-fold higher risk of hospitalization for POP than nulliparous women, and the risk was eight times higher for second-born mothers. The risk of prolapse may be greater if the baby is born with a heavier birth weight and the labor is longer.

Other associated risk factors include:

Age: The older you are, the higher your risk of POP. Studies have reported that the risk of prolapse increases by 40% with every 10-year increase in age.

Obesity: A meta-analysis showed that the risk of POP in overweight and obese women was 40% and 50% higher, respectively, than that in normal-weight women.

Family history of prolapse: Women with a family history of prolapse have a 2.5-fold increased risk of developing the condition, and also have a higher risk of recurrence after surgical treatment.

There are also some diseases that may be related to POP, such as connective tissue diseases such as Marfan syndrome (which may cause collagen abnormalities) and chronic constipation (repeated increases in intra-abdominal pressure). It is important to note that prolapse does not only occur in women who have given birth.

Pelvic organ prolapse may be asymptomatic , but treatment is recommended for those with symptoms

Pelvic organ prolapse may affect the function of the bladder and urethra, such as complications such as stress urinary incontinence, urgency, frequent urination, and urinary incontinence during sexual intercourse. Some patients also report symptoms such as constipation and incomplete defecation.

Some patients do not have the above symptoms, but when they come to see a doctor, they report that "I feel something falling out from there" or "I feel there is something in my vagina after standing for a long time, and I can touch it with my hand."

Some women with mild prolapse have no symptoms, and most of them only discover the prolapse problem during routine gynecological examinations.

In fact, pelvic organ prolapse itself is not a serious disease that threatens life, but something falling out of the vagina is really terrifying and greatly affects daily activities. Therefore, even if there is no urinary, bowel or sexual dysfunction, it will cause great pain to patients.

Generally speaking, women with symptoms or functional impairment are advised to receive treatment, which can be roughly divided into conservative treatment and surgical treatment . It is recommended that patients receive formal diagnosis, clarify the site and degree of prolapse, and then receive individualized treatment under the guidance of a doctor.

Conservative treatment is the first-line option for all women with pelvic organ prolapse and includes vaginal pessary placement and pelvic floor muscle exercises.

1Vaginal Pessary

A vaginal pessary looks like this:

Using a pessary to support the pelvic organs is relatively safe, has good therapeutic effects, is highly accepted, can be used for a long time, and is cheaper than surgery. Ring pessaries (F, G, L) are more commonly used, have a better fit, and are easy to remove, clean, and insert. For patients with more severe prolapse, a pessary with a filling (K) may be more effective.

2. Pelvic floor muscle exercises

The improvement is usually better when the pessary is combined with pelvic floor muscle exercises , such as Kegel exercises:

Step 1: Contract. Contract your pelvic floor muscles (the muscles around your vagina and anus) and imagine actively stopping the flow of urine when you urinate.

Step 2: Hold and continue to contract your muscles for 8 to 10 seconds

Step 3: Relax and fully relax your pelvic floor muscles

Repeat the above actions 8 to 12 times, three times a day, for at least 15 to 20 weeks. Exercise requires long-term persistence to be effective.

Note:

Pelvic floor muscle exercises are part of the treatment. It is not recommended to randomly find videos and follow them online. Before exercising, you should receive a formal prolapse diagnosis and pelvic floor muscle strength assessment. It is recommended to consult a doctor for specific exercise methods and force methods. Do not blindly start high-intensity exercise after delivery. Please perform exercise and post-exercise evaluation under the guidance of a doctor.

3. Surgical treatment

Surgical treatment is mostly suitable for patients who have failed conservative treatment or refuse to accept conservative treatment. There are many surgical methods, such as reconstruction (using surgical reconstruction to correct vaginal prolapse), colpocleisis/resection, hysterectomy, repair through ligament fixation, suspension and other methods, and enhanced repair using surgical mesh patches, etc. The specific surgical plan needs to be formulated according to the patient's own condition and needs.

Generally speaking, conservative treatment (pessary combined with pelvic floor muscle exercise) is more acceptable. On the one hand, there is no risk of complications and recurrence caused by surgical treatment. On the other hand, the effect of conservative treatment is also good under the premise of good compliance. However, for older women, especially those with severe prolapse and urinary and defecation symptoms, surgical treatment is more effective once and for all.

Will uterine prolapse occur if you choose cesarean section when giving birth?

It's hard to say. Although vaginal delivery is one of the factors that increases the risk of prolapse, it is not clear whether cesarean section can prevent prolapse because pregnancy itself can cause damage to the pelvic floor muscle function.

To be honest, there is no good way to prevent pelvic organ prolapse. Being overweight is one of the risk factors for prolapse, but there is no evidence to support whether losing weight can reduce the occurrence of prolapse. However, it is still recommended that everyone manage their weight well, after all, this is beneficial and harmless.

Finally, it is recommended that patients with symptoms of prolapse, especially those with concurrent urinary and bowel problems, receive formal evaluation, diagnosis and treatment in a timely manner. Pelvic organ prolapse is not a shameful thing, and it is not difficult to solve . There are currently good medical means to deal with it.

References

[1]UTD: Epidemiology, risk factors, clinical manifestations, and management of female pelvic organ prolapse

[2] UTD: Indications, devices and selection methods for vaginal pessaries

[3]UTD: The first surgical option for female pelvic organ prolapse

[4]https://link.springer.com/article/10.1007/s00192-021-05018-z

Planning and production

Source: Dr. Ou Xi (ID: drouxi)

Editor｜Yang Yaping