Question

I have a uterine prolapse following the delivery of a large baby and I seem to leak urine, not constantly, but some days more than others. If I want to walk or play sport I need to wear a pad and/or a tampon. I am 44. What's the solution, or is it a problem I have to live with?

Answer

If you have uterine prolapse, it means that your uterus has tilted or slipped. Sometimes it slips so far down that it reaches into the vagina. This happens when the ligaments that hold the uterus to the wall of the pelvis become too weak to hold the uterus in its place. Multiple pregnancies or large babies can be contributing factors.

Uterine prolapse can cause feelings of pressure and discomfort, and urine may leak. Treatment choices depend on how weak the ligaments have become, your age, health, and whether you want to become pregnant again. Options that do not involve an operation include:

Exercises (called Kegel exercises) can help to strengthen the muscles of the pelvis. How to do Kegel exercises: Tighten your pelvic muscles as if you are trying to hold back urine. Hold the muscles tight for a few seconds and then release them. Repeat this exercise up to 10 times, up to four time every day.

Inserting a pessary - which is a rubber, diaphragm-like device - around the cervix to help prop up the uterus. The pessary does have drawbacks. It may dislodge or cause irritation, it may interfere with intercourse, and it must be removed regularly for cleaning.

Surgical treatments include:

Tightening the weakened muscles without taking out the uterus. This is usually done through the vagina, but it also can be done through the abdomen. Although this is a type of surgery, it is not as extensive as a hysterectomy.



Hysterectomy. Doctors usually recommend this operation if symptoms are bothersome or if the uterus has dropped so far that it is coming through the vagina.