Doctor Segment - Q.Can the uterus "fall down"?

DOCTOR;The condition in which the uterus is" falling" is usually referred to by doctors as uterine prolapse or uterine decensus or procidentia. This is a situation in which the ligaments that holds the uterus in place are no longer strong enough to hold it where it belongs.This is usually a result of the stretching and tearing of these ligaments during childbirth,but the ligaments can also be abnormally weak (apparently an inherited weakness) in women who have never been pregnant.

Often a doctor will tell a patient that her uterus has fallen and she is totally unaware of it.In this situation,the patient does not need to do anything about it and can usually ignore any suggestions a doctor might have about surgery.It is  a problem only if it is bothersome.

Occasionally a uterine prolapse will cause a woman to have low abdominal and low back pain.If a woman begins having trouble with uterine prolapse and has had all the children she wants,she should consider a vaginal hysterectomy.Uterine prolapse is often associated with a prolapse (relaxation) of the vaginal walls known as cystocele and or rectocele.If the vaginal walls are becoming weakened and these problems are bothering her and she has decided to have a hysterectomy,she should also have vaginal repairs.

If a woman wants more children or does not want to have surgery,she can either ignore the problem or have uterus pushed back up the vaginal canal with a pessary.A pessary is a plastic or rubber device that is inserted into the vagina for the purpose of holding up the uterus on a temporary basis.With some pessaries a patient can have intercourse;with others intercourse is impossible.

If a woman has prolapse of the uterus,has not completed her family,and cannot wear a pessary,she needs to have an abdominal operation in which the doctor would make an incision,grasp the ligaments of the uterus and shorten and tighten them to hold her uterus higher up in the vagina.Some doctors are now doing this with the laparoscope.

Occasionally doctors will fit a woman with a pessary when they feel that she is too old or too ill to have surgery.l have never seen a woman alert enough to be bothered by vaginal relaxation who was not also healthy enough to have vaginal surgery.Most women can have vaginal surgery because it does not stress a woman's body very much and can be done relatively quickly.Often older women who try to avoid surgery by using a pessary tire of it after a few months and go ahead with surgery.

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