THE condition in which a woman's uterus slips out of its normal position in the pelvis to lie further down in the vagina and sometimes outside of the vagina is known as uterine prolapse.

This disorder comes about when the pelvic muscles and ligaments stretches and weakens, therefore taking away the support for the uterus. This stretching of the muscles can be due to a number of factors. These include vaginal delivery resulting in the damage of supportive tissues during pregnancy and childbirth, and the loss of oestrogen, which is what helps to strengthen the pelvic muscles. The reduction in muscle tone, which usually occurs during menopause, or a tumour in the pelvic cavity, can also lead to uterine prolapse.
Other factors such as chronic coughing, frequent heavy lifting, obesity and chronic constipation tends to place added tension on the pelvic muscle and may contribute to its development.

According to Head of Department of Obstetrics and Gynaecology at UWI, Dr Horace Fletcher, uterine prolapse is a common problem amongst women in Jamaica.

"I have seen many patients with the condition to varying degrees. Some have mild prolapse and have no complaints. The condition is only recognised when the woman is examined by her doctor. Some have more severe prolapse and have symptoms such as fullness in the vagina, a mass coming out of the vagina on standing or straining, urinary symptoms such as wetting themselves on coughing, laughing or on lifting heavy objects," he said.

He said the most common reason for the disorder is childbirth. If a woman he said, "Starts pushing to have the baby before the neck of the womb (cervix) is open or if she has the baby too fast she can damage the support of the uterus and cause prolapse".

Dr Fletcher believes the best way to prevent prolapse is to not have too many children and having a competent trained person supervise their deliveries to avoid straining and damage to the pelvic structures. In addition to this he says, "If the woman has had damage during childbirth or if she has a family history of prolapse, she should avoid smoking or other conditions that may cause chronic coughing or sneezing. She should also avoid lifting very heavy things and avoid straining to pass stool (constipation) or straining to pass urine".

Some of the symptoms of severe uterine prolapse are:
1. Pain in the pelvis, abdomen and lower back.
2. A sensation of heaviness or pulling in your pelvic area.
3. Urinary difficulties such as urine leakage and urinary frequency.
4. Unusual or excessive discharge from the vagina.
5. Constipation.
6. Pain during intercourse.
7. Tissue protruding from your vagina.

If you are witnessing more than three of these symptoms, then it's important to visit a health practitioner, preferably a gynaecologist.

Treatment for uterine prolapse

Non-surgical options Exercise
Special exercises known as Kegel exercises can be used to strengthen the pelvic muscles in mild cases of prolapse.

Taking oestrogen
This can limit the further weakening of the muscles and tissues that support the uterus.

Vaginal Pessary
This is a small instrument that holds the uterus in place when it is inserted. It comes in many different shapes and sizes.

Surgical options Hysterectomy
The uterus can be removed by conducting a surgical procedure called a hysterectomy. This is a serious surgery and usually means that you would not be able to have children. However, Dr Fletcher says that in women who wish to have children, the repair can be done without doing the hysterectomy. For this, the woman's cervix would be cut off (amputated) and then the stitching of the neck of the womb will follow to help keep the pregnancy in.

Uterine suspension
This involves pulling back the uterus in its normal position. This may be done by reattaching the pelvic ligaments to the lower parts of the uterus to hold it in place. A special material that acts like a sling can be used to support the uterus in its proper location. These surgeries can be done using invasive and laparoscopic techniques that reduce post-operative pain and results in a speedy recovery.

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