Dr Maxwell Adeyemi

The uterus (womb) is a muscular structure held together by pelvic floor muscles and ligaments. Pelvic floor muscles are the muscles, ligaments, and tissues in the pelvis (area of the body below the abdomen).

The uterus, bladder, vagina, rectum (part of the large intestine terminating at the anus), and other pelvic organs are all supported by these muscles. When the pelvic floor muscles are damaged or weakened to the point where they can no longer provide support, a prolapse occurs.

Uterine prolapse occurs when the pelvic floor muscles and ligaments stretch and weaken due to pregnancy, childbirth or difficult labour to the point where they can no longer support the uterus. As a result, the uterus descends and enters or protrudes from the vagina.

Uterine prolapse is most common in women who have had one or more vaginal deliveries after menopause due to the natural loss of the hormone estrogen.

Uterine prolapse can be mild or severe, depending on how weak the uterine supporting muscles have become. Normal activities can be disrupted and made uncomfortable by uterine prolapse. Very mild cases may not necessitate treatment or cause any discomfort. However, severe cases may make it difficult to pee or have a normal bowel movement.

Uterine prolapse is typically a quality of life issue, and healthcare providers treat it when symptoms begin to interfere with daily life.

Stages of uterine prolapse

Uterine prolapses are classified as either incomplete or complete.

Incomplete uterine prolapse - In an incomplete uterine prolapse, the uterus partially displaces the vagina but does not protrude and may lead to a lump.

Complete uterine prolapse - In a complete uterine prolapse, a portion of the uterus protrudes from the vaginal opening or the introitus.

Muscle weakness may cause the uterus to sag or completely exit the body in stages. The severity of this condition is graded into four stages.

First degree: The cervix (opening/neck of the womb) drops into the vagina.

Second degree: The cervix descends to the level just inside the vaginal opening.

Third degree: The cervix is outside the vagina.

Fourth degree: The entire uterus is outside the vagina leading to a condition known as procidentia. That is, the lack of strength in all of the supporting muscles.

Causes of uterine prolapse

The following are some of the causes of weakened pelvic muscles and tissues that may eventually lead to uterine prolapse:

* Vaginal birth

* Age at first delivery (older women are at higher risk of pelvic floor injuries compared with younger women)

* Difficult labour or childbirth trauma

* Being overweight or obese during childbirth

* Lower estrogen levels following menopause leading to loss of muscle tone

* Constipation or straining with bowel movements on a regular basis.

* Bronchitis or chronic cough

* Smokin