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The uterus is the female reproductive organ. The base of the uterus is the cervix, which is connected to the vagina, the female reproductive opening. The uterus and vagina are held in place by multiple ligaments, muscles and other connective tissue. When these structures get prolapsed, it means they are falling out of the body and slipping from their normal positions. The uterus can partially fall out of the body in a “partial prolapse” or completely out of the body. Any time a portion of the uterus can be seen on the outside, it is called a “complete prolapse”.
The vagina usually falls along with the uterus. Other pelvic organs can fall along with the vagina and the uterus, such as the bladder and the urethra. When this happens, there is usually a necessary surgery in the woman’s future.
Some women have few or no symptoms of a vaginal or uterine prolapse. Others begin to have symptoms as the uterus begins to sag. Symptoms include:
Symptoms of uterine prolapse often get worse with prolonged walking or standing because gravity is pulling down on the organs.
What causes pelvic prolapse? It has an increased risk of occurring in women who have had at least one vaginal birth. The normal aging process occurs along with a lack of oestrogen following menopause and this triggers a weakening of the pelvic floor muscles. Rarely there can be a pelvic tumour that weakens the muscles and pushes on the uterus but this is uncommon. Women can have chronic constipation and, with pushing stool out, can weaken the pelvic floor muscles.
The diagnosis of a pelvic prolapse involves a thorough pelvic examination along with a physical examination and medical history. When you are examined lying down and standing up, you can see a difference in the uterine and pelvic position. An MRI examination can sometimes show the relationship between the pelvic tissues and abdominal tissues.
Treatment is only necessary if there are uncomfortable symptoms. By the time a prolapse becomes symptomatic, exercises like Kegel exercises are generally insufficient and surgical options are the only real choices to make. For women with the need for surgery, minimally invasive surgery is best. For prolapse, a woman can have a vaginal hysterectomy if the vagina hasn’t become too prolapsed.
Another option is the traditional laparoscopy. There are multiple small incisions in the abdomen and a tiny camera guides tools used remove or repair the uterus so it is in place again. The muscles of the pelvis are reinforced.
In the da Vinci surgery, the surgeon uses a few small incisions and special high definition visual systems to repair the uterus. Robotics are used along with special instrumentation that can go above and beyond normal laparoscopic surgery.
The complications of these surgeries include abnormal bleeding, pelvic infection, or damage to abdominal and pelvic structures. All three of these surgeries involve a narrow field of vision so it is possible to fail to see something that is unfortunately cut or otherwise damaged. Life threatening surgery can occur necessitating another operation or an unexpected hospitalization due to complications. Internal scarring can be one of the unintended long-lasting complications as it is very difficult to get rid of or remove. Nerve damage is possible that can affect female sexual functioning; this can be temporary or permanent.
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