Dr.bhupendra bathla

Uterine Fibroids/Prolapse

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Uterine fibroids

Uterine fibroids are benign tumors that originate in the uterus (womb). Although they are composed of the same smooth muscle fibers as the uterine wall (myometrium), they are much denser than normal myometrium. Uterine fibroids are usually round. In most cases, fibroids do not cause pain or other symptoms. However, exceptionally large fibroids may cause pressure on the bladder or other organs, leading to specific symptoms

Uterine fibroids are often described based upon their location within the uterus.

Subserosal fibroids are located beneath the serosa (the lining membrane on the outside of the uterus). These often appear localized on the outside surface of the uterus or may be attached to the outside surface by a pedicle.

Submucosal (submucous) fibroids are located inside the uterine cavity beneath the inner lining of the uterus.

Intramural fibroids are located within the muscular wall of the uterus.

Intramural fibroids are located within the muscular wall of the uterus.

Edunculated fibroids grow on a stalk of tissue known as a pedical (like a mushroom), extending either inside the cavity of the uterus or outside the uterus from its outer surface.


Uterine prolapse

There are three main organs that are present in the pelvis: the womb, the urinary bladder and the lower end of the bowel i.e. rectum. All three of them open to the outside through the pelvic floor. They are supported above by the pelvic floor muscles and the ligaments. When these become weak then the organs bulge through the vagina. This bulging is called prolapse. These can be of various degrees; the worst is when they protrude completely outside the vagina.

Prolapse is very common. Women usually complain of

1. Feeling a dragging sensation down below.
2. Low back pain
3. They can feel a part of an organ at the entrance to the vagina
4. Sometimes they need to push the organ inside in order to be able to empty the bladder or bowel completely.
5. Sexual Discomfort
6. Frequent urinary infection.
7. Leaking of urine when coughing, laughing, and routine day to day activities.

Causes of prolapse

Childbirth is the most important cause of prolapse. The delivery weakens the pelvic floor muscle. This is worsened in case of prolonged labor, difficult delivery, forceps delivery, and multiple deliveries. Aging is an important cause of muscle weakening. It is further accelerated after menopause. All factors that increase the pressure within the abdomen like chronic cough, chronic constipation, regular weight lifting, can weaken the floor muscles and lead to prolapse.

Obesity can contribute to all above factors. If you think that you have the above symptoms then you should seek an appointment with Dr. Gunjan. Diagnosis is very easy and can be done by the gynecologist in a routine internal examination in the out-patient department.

After the examination it is possible to tell whether you have prolapse and also which organ is prolapsing.

E.g. Urinary bladder – cystocele
Rectum – rectocele
Uterus – uterine prolapse
Small bowel – enterocele

The management options depend on the type of prolapse, degree of prolapse, and individual factors such as age, general health, weight and desire for child bearing.It is worth trying to loose weight and stop smoking prior to treatment. It is also imperative to treat chronic cough and chronic constipation if they exist. Pelvic floor exercises also known as kegel’s exercises can go a long way in preventing prolapse and also help in mild cases. Vaginal pessary is a silicone ring like device that fits into the vagina and helps to hold up the pelvic organs. They are a good option when surgery is not an option due to age or medical condition. The pessary needs to be changed or removed, cleaned and reinserted regularly.

Surgery

There are many different operations that can be done to treat prolapse. This will depend on the type of prolapse, the symptoms, age, and generalhealth; wish to have sexual intercourse and whether or not family is complete. Surgery for prolapse may not be advisable if child bearing is desired as the prolapse is more likely to come back afterwards.The commonest surgery is removal of uterus {usually done through the vagina} and pelvic floor repair where the walls of your vagina are tightened up to support the pelvic organs. A new development is the insertion of a synthetic mesh in the walls so as to strengthen the support. This procedure is not yet common as its results are not yet certain. The top end of the vagina may be attached to the lower end of the spinal bone or ligament to further hold it up.The surgery does give relief to vast majority of women, but it is important to remember that as aging continues, the muscles may become weaker again and the prolapse may recur.