Tackling uterine prolapse

Dear Dr Mitchell,

I have read a lot of articles regarding low cervix. I live a sedentary lifestyle at the moment because of postgraduate school. I have been smoking for the past four years, and as much as I can recall, there were a few times I lifted heavy baggage.

From what I’ve read, these could be the reasons I seem to have a low cervix. However, I’m not sure. I can only rely on trying to feel it, and I attempted to measure mine from instructions I saw online.

What was left outside was the length of my index finger up to the first crease only. Is this normal? Would it be possible to have normal pregnancy?

I am worried because I am just 25 and uterine prolapse scares me. I want to have a normal pregnancy in the future. Please tell me it’s not too late.

A cervix that is felt low down in the vagina may be due to one of several factors, including an abnormal elongated lip of the cervix, an abnormal growth on the cervix, or a weak pelvic floor with descent of the uterus and cervix into the vaginal canal.

A weak pelvic floor may be due to several factors. Anything that causes excessive pressure on the pelvic floor can cause the muscles to become overstretched with damage to the nerve supply, and this then results in the vaginal wall with the bladder, rectum, uterus, and cervix falling down into the vaginal canal. In severe cases, these can fall completely outside of the vagina.

Some of the causes include a chronic cough, which is seen in people who smoke as well as those who have asthma, emphysema and chronic bronchitis. Women who are overweight with a large anterior abdominal wall overhang are at an increased risk for uterovaginal wall prolapse.

Also, poorly controlled diabetes mellitus can cause damage to the nerves that supply the pelvic floor and result in pelvic floor prolapse. Older women with low oestrogen levels, especially after menopause, may also develop weakness in the pelvic floor muscles and end up with a prolapse.

Women who have a lot of children and have vaginal birth are also at an increased risk for uterine prolapse. This is worsened if there is a prolonged period of pushing to deliver the baby, or if there is a rapid delivery with damage to the pelvic floor muscles. The use of forceps and vacuum to expedite delivery may also cause damage to the pelvic floor and result in prolapse of the uterus in later life.

Prevention of pelvic floor damage is important. Smoking is generally bad for your health and increases the risk of all cancers. This should definitely be discontinued. Maintaining your ideal weight for your respective height is also important. Focused exercise to reduce belly fat is extremely important in reducing the pressure on the pelvic floor; it is also important to control your blood sugar if you are a diabetic, since poor glucose control can lead to damage to the nerves that supply the pelvic floor muscles.

It is important for you to have a complete physical examination and a pap smear done to ensure that your cervix is otherwise normal, and to determine if there is definitely uterovaginal prolapse. If there is prolapse of the uterus and cervix at this early age, then you should do some pelvic floor exercise to strengthen the muscles (Kegel exercises).

How to do Kegel exercises

To get started:

• Find the right muscles: To identify your pelvic floor muscles, stop urination in midstream. Once you’ve identified your pelvic floor muscles, you can do the exercises in any position, although you might find it easiest to do when lying down at first.

• Perfect your technique: To do Kegels, imagine you are sitting on a marble and tighten your pelvic muscles as if you’re lifting the marble. Try it for three seconds at a time, then relax for a count of three.

• Maintain your focus: For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises.

• Repeat three times a day. Aim for at least three sets of 10 to 15 repetitions a day.

You can have a normal pregnancy with uterine prolapse, but you will definitely need to be delivered by caesarean section to prevent further pelvic floor damage. Consult your doctor who will advise you further.

Best regards.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com ; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.

DISCLAIMER:

The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.