uterus, prolapsed

Condition in which the uterus (womb) hangs too low in the vagina, or sometimes protrudes from it, particularly after the menopause, and often connected with an earlier difficult childbirth. The prolapsed womb can also pull on the bladder, causing bladder complaints. Prolapse gives a heavy feeling in the lower abdomen, and risk of bladder infection is increased. It is caused by stretching of the ligaments which support the womb and slackening of the pelvic muscles. It can be prevented by care during childbirth, post-natal muscular exercise and avoiding excessive weight. Treatment can be of three kinds. A pessary can be fitted if an operation is not advisable; the pessary must be regularly checked because it can cause pressure points and inflammation. In older women the womb can be removed surgically (hysterectomy), together with a pelvic floor repair. In younger women who still wish to have children treatment is by pelvic floor repair alone. The condition can recur after subsequent childbirth. The uterus (womb) is aligned forwards in 80 to 90 percent of Western women, but in Eastern Asiatic women the situation is reversed; 80 to 90 percent of women have retroversion of the uterus. Thus the condition is a normal variation. Only 5 per cent of women with retroversion of the womb have resultant difficulties: back pain, heavy menstrual flow and sometimes infertility. If the retroverted womb is stuck in the pelvis (extremely rare), there can be problems in pregnancy because the womb cannot then grow normally. Only women with otherwise inexplicable pains in the lower abdomen are treated for the condition by insertion of a pessary to correct the alignment. Diagnosis is usually by a gynaecologist, but the pessary can be fitted by the family doctor.

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