A lowering of the uterus can occur when the muscles and connective tissue of the female pelvic floor relax. If these structures are no longer able to hold the uterus, it sinks down. The medical term for uterine prolapse Descensus uteri. Sometimes the uterus sinks so far that it protrudes partially or completely from the vagina. Doctors then talk about a uterine prolapse or uterine prolapse.
Experts estimate that about 30 to 50 percent of women have uterine prolapse or uterine prolapse. Most often this happens during or after the menopause, ie older women. But even young women are not immune to uterine erosion, for example, after a pregnancy.
It is not necessarily the case that uterine depression is accompanied by pain or other symptoms. There are women who have this process without symptoms. The first sign of uterine depression is a downward pressure sensation to the vagina. Many also have the feeling that a foreign body is in the vagina.
In addition, uterine reduction can cause discomfort such as:
- Pain in the lower abdomen: The uterus "tugs" by sinking at the ligaments on which it is hung.
- Involuntary loss of urine: Urinary incontinence occurs when the pelvic floor is overstretched and the urethra loses its grip on the tissue.
- Problems with bladder emptying or bladder infections are also possible.
- Pressure ulcers occur when the vaginal mucosa or the cervix occur. These ulcers make it easier for bacteria and fungi to settle. Then it comes to bleeding and / or foul-smelling discharge,
- If the rectum invades the vagina due to uterine erosion, defecation problems may result.
- If the vaginal obstruction is disturbed by the protuberance, the vagina may become inflamed (colpitis)
- It is also very common for women to have lower back pain when they lower the uterus.
Tip! Pelvic floor exercises can help to slow down the decline of the uterus and regulate incontinence. It is advisable to pelvic floor training especially in the course of pregnancy or in a decay of the uterus after birth. How long it takes for the anatomical condition to improve again varies considerably from woman to woman. Some go by for a few months, others do not succeed at all.
Doctors classify the uterine sinking in four stages or degrees of severity:
- Grade 1: The uterus does not reach the vaginal entrance after lowering.
- Grade 2: If the uterus has lowered to the entrance to the vagina, this means a second degree uterine sinking.
- Grade 3: This stage is reached when the uterus has pushed past the vaginal entrance.
- Grade 4: The uterus has slipped out through the vagina. In a uterine 4th degree, doctors also speak of a total prolapse.
If you experience symptoms of uterine erosion, you should visit your gynecologist. He will first talk to you and ask you some questions about the medical history (anamnesis). So he finds out:
- what complaints you have exactly
- when the symptoms occur and how pronounced they are
- how many births you had or
- whether other causes, for example menopause, are the trigger for the complaints.
The patient talk is followed by a gynecological examination. A uterine depression can be felt. In addition, your doctor assesses the position of the pelvic floor and the female genitalia during pressing.
A full bladder cough test will help you to check if you are losing urine. This is a sign that the urethra has loosened. If there is an incontinence, the residual urine can be determined by means of ultrasound (ultrasound). If urine remains in the bladder, infections are more likely.
Other possible studies providing evidence of uterine erosion are:
- Determination of bladder pressure
- Bladder reflexion (cystoscopy)
- Ultrasound (sonography) of bladder and kidneys
- Examination of defecation
A uterine depression is not an independent disease. Rather, it is a symptom that the pelvic floor is too weak or is gradually getting weaker. Therefore, only the symptoms of uterine eradication can be treated. However, women can prevent further subsidence through pelvic floor training.
Doctors initially use conservative therapy (without surgery) to lower the uterus. If the reduction is severe, women can also help with surgery. The right treatment depends on your condition, concomitant symptoms (such as incontinence), age, general health, or desire to have a baby.
Conservative therapy: treat uterine erosion without surgery
Doctors treat the uterine cavity without surgery. Conservative methods often achieve good results with a slight reduction in uterus and minor incontinence. These measures include, for example:
- Reduce or eliminate risk factors such as heavy smoking, chronic constipation or severe obesity
- Learn techniques for correct lifting and carrying
- Exercise the pelvic floor regularly during and after uterine erosion exercises and strengthen the support structures
- Use pessary, a small ring, cube or a shell of rubber. The doctor or you put it in the vagina, where the remedy to stabilize the uterus. Usually an estrogen therapy supplements the treatment, so that the pessary does not damage the vaginal mucous membrane.
Tip! Exercises, for example in the form of pregnancy or recovery gymnastics, can also prevent uterine prolapse in (early) pregnancy.
Although conservative therapies can not completely reverse a uterine prolapse, the measures help keep the womb from sinking even further.
Uterine lowering surgery
Sometimes the conservative treatments do not bring enough success. Then the uterine sink can be treated by surgery. It is also a possibility if the reduction is more pronounced or the uterus has partially occurred. Several surgical procedures are available:
- Sheath fixation on the lateral pelvic wall (sacrospinal colpopexy)
- Procedures that use the nearby ligaments to fix the uterus and vagina
- Scheidenraffung / Scheidenplastik (Kolporrhaphie)
- Methods in which tissue nets hold the organs and the pelvic floor (mesh insert)
With concurrent incontinence, there are also surgical procedures designed to improve the angle between the urethra and bladder. Women who are no longer of childbearing age can use a combination procedure. The surgeon removes the uterus through the vagina, gathers the vagina and sutures the vaginal tissue.
The cause of uterine erosion is a (too) weak pelvic floor. He can no longer hold the uterus and other nearby organs in the correct position - so they gradually sink down.
The pelvic floor consists of several layers of muscle and connective tissue. Only by the upright gear he has to withstand heavy loads. If additional pressure is added, it can be too much for the pelvic floor. This is why it is not uncommon to have a uterine cavity after birth. The stretching of the holding apparatus caused by the baby then does not completely recede. Preventing (expectant) mothers by pelvic floor training. Likewise, a uterine depression caused by heavy lifting.
Other causes of uterine erosion are:
- Chronic constipation: When pressed, tremendous pressure is created on the abdomen
- Coughing attacks also generate great pressure
- Overweight or obesity (obesity): The many pounds press on the abdomen
- Age: The tissue, tendons and ligaments become weaker with increasing years
- A naturally weak pelvic floor (connective tissue weakness)
- low estrogen levels, around menopause
A uterine depression can have some consequences. For example, some women experience sexual intercourse during uterine erosion as painful. Some suffer from stress urinary incontinence (also known as stress incontinence) in which women involuntarily lose urine during exercise such as coughing or laughing. In addition, recurrent cystitis is possible.
If the doctor treats the uterine lining surgically, it can also have undesirable consequences. An operation always involves risks, as in this case, for example:
- Wound infections and adhesions after the procedure
- Problems with urination
- Pain during sex
The surgery itself only requires a short stay in the hospital. You have to expect three to five days. However, you should save a while after a uterine hypertensive operation. How long they feel sick varies individually. Where "sick" is not really the right word. Most of the time, you can return to your daily routine a few days later and work normally. It should only:
- nothing heavy lifting,
- do not strain yourself physically,
- at least in the first two weeks after the procedure do not do sports and
- abstain from sex for six weeks.
First and foremost, after a uterine abdominal surgery, you should do one thing above all else: listen to your body and rest accordingly.