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Uterine And Bladder Prolapse

Prevention & Treatment

Monday, Aug. 27, 2007; 7:47 PM

Copyright Harvard Health Publications 2007

Prevention

Table of Contents

You can take some simple steps to limit stress on the pelvic support system, especially if you have given birth. Limit heavy lifting and avoid unnecessary straining to have bowel movements. Avoid smoking so that you have a lower risk of chronic cough. Maintain a normal body weight through careful diet and exercise.

Estrogen supplements after menopause have been credited with helping to maintain strong pelvic muscles and ligaments, but there is no strong evidence that hormone replacement medicine after menopause prevents or treats a bladder or uterine prolapse. There are known health risks associated with hormone replacement, and in most women, the risks outweigh the benefits. If you are interested in taking hormone replacement medication, you should review the pros and cons of this treatment with your physician.

Treatment

For mild cases, measures to strengthen pelvic floor muscles may be enough to limit symptoms of prolapse. Exercises known as Kegel exercises are an excellent way to increase your pelvic support. To perform Kegel exercises, you need to squeeze the pelvic floor muscles that you would use if you were trying to hold back urine or trying to stop urinating when your bladder was only partly empty; but do not perform the exercises routinely while urinating. Most doctors advise women with pelvic muscle weakness to tighten these muscles and hold them tight for a few seconds at a time. Repeat the exercise ten times in each session and do approximately four sessions each day. Over time, most women notice improvement in bladder control and may have less pain or fewer symptoms.

A physician can fit a rubbery, ring-shaped device called a pessary into the upper portion of your vagina. Pessaries can help to prop up the uterus and bladder and prevent them from sagging into the vagina. They are removable so they can be washed periodically.

A prolapsed bladder or uterus may need to be corrected with surgery, which can be done through the vagina or the abdomen. The procedure that is chosen depends on the woman's age, severity of the symptoms, medical history, desire for future fertility and desire to be able to have sex. The goals are to restore normal anatomy, relieve symptoms, restore normal bowel and bladder function, and restore the ability to have sex. In some cases, surgical removal of the uterus (hysterectomy) is recommended.

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