Introduction
A uterus prolapse describes the prolapse of the uterus in its holding apparatus. This means that the uterus sinks down and can push itself into the vagina. The uterus is not yet visible from the outside. However, it can happen that the uterus sinks down so far that a prolapse of the uterus can occur, i.e. the uterus protruding from the vagina (so-called prolapse uteri). In this case, the uterus may even be visible from the outside.
Causes
The cause of uterine prolapse can be weak connective tissue. As a result, the ligamentous structures with which the uterus is anchored in the pelvis can no longer hold the uterus so tightly in its actual position. Another cause can be a weakness of the pelvic floor.
A weak pelvic floor can occur after a pregnancy, for example. If the pelvic floor muscles are not strong enough, this means that the uterus can no longer be held properly either and the uterus can drop, sometimes with simultaneous pelvic floor prolapse. Obesity can also be the cause of weak pelvic floor muscles and thus uterus prolapse.
A uterus prolapse is also always associated with the fact that the anteversio and anteflexio of the uterus are suspended. This means that the uterus now stands more vertically in the pelvis (retroversio and retroflexio). If the anterior vaginal wall is lowered, the posterior bladder wall may also lower (cystocele).
If the posterior vaginal wall is lowered, the same happens to the anterior intestinal wall, i.e. the rectum is lowered into the vagina (rectocele). A pregnancy means that the uterus is exposed to special conditions. The organ, which is normally quite small, grows to a much larger size and is under considerable strain.
Because the unborn child and the uterus are much heavier, this weight then puts additional strain on the pelvic floor. As a result, the muscles and ligaments of the pelvic floor can already be subjected to increased strain during pregnancy and a certain weakness can develop. A slight lowering of the uterus during pregnancy does not necessarily mean that the alarm level is at its highest.
It becomes more critical, of course, when the uterus prolapses to a certain degree. If this happens, so-called pessaries can be inserted. A pessary in this case would be a hard plastic piece in the form of a ring, which is inserted by the gynaecologist and supports the uterus and cervix in their postural function.
However, such a pessary should be checked and changed regularly to ensure the correct fit and to prevent infections. A risk factor for uterine prolapse is natural childbirth. As natural childbirth puts a particular strain on the ligamentous apparatus and the muscles of the pelvis, a weak pelvic floor can occur afterwards.
Especially if additional birth injuries have occurred, this increases the risk of weakening the muscles and ligaments. The weakness of the pelvic floor can then in turn cause the uterus to descend. There are many possibilities to treat pelvic floor weakness after birth.
With each subsequent pregnancy or vaginal birth, the risk of pelvic floor weakness and thus uterine prolapse increases. A further stress factor in a natural birth is a prolonged period of expulsion or the use of obstetric forceps. In general, however, it is true that uterus prolapse does not occur immediately after every natural birth.
As a preventive measure, it is important to avoid heavy physical work in the puerperium. This would have a further effect on the weakened musculature after birth and promote the development of uterus prolapse. In the same way, a certain amount of postpartum exercise is recommended in order to strengthen the stressed muscles and counteract weakness of the pelvic floor.
A caesarean section alone does not represent a risk factor for uterus prolapse. A Caesarean section opens the uterus through an incision in the lower part of the abdomen and thus the child is born. This means that the pelvic tissues and the pelvic floor muscles do not have to expand as they would in a natural birth, as the uterus is opened above these structures.It is precisely this excessive stretching that later causes the uterus to descend, which is why there is not necessarily a higher risk of descensus after a Caesarean section.
However, every pregnancy represents a risk factor for uterus prolapse in later life. Age is a significant risk factor for the development of uterine prolapse. Especially during the menopause and afterwards, the tissue of the supporting apparatus in the pelvis loses more and more elasticity and thus only allows the uterus to descend.
In addition, the blood supply to the muscles of the pelvic floor is also weaker, causing the muscles to lose strength. These changes are partly caused by the fact that the body changes its hormone balance during the menopause. Therefore, local therapy with the hormone estrogen can be effective in counteracting uterine depression during the menopause. The hormone is either applied in the form of creams or suppositories in close proximity to the uterus or a vaginal ring can be used to secrete the hormone.
