G had gone through menopause. She was alarmed and troubled when she saw blood dripping from the swelling at her vagina. The source? A bleeding ulcer at the apex of the lump. “For the first few years after menopause, I have noticed a swelling 'coming out' of my vagina whenever I strain during defecation or lifting heavy objects and it disappears after I lie down and rest.” She said. “As it is painless, I did not pay much attention to it. But the lump has become bigger with time and has not receded for the past 5 months. It has caused more and more discomfort whenever I walk. I feel as if something is stuck at my bottom.”
After she saw the bleeding, she called her daughter straightaway who promptly brought her to see me.
“Doc, I am scared. Could this be a sign of cancer?” She asked, looking worried. Examination revealed that G had half of her uterus prolapsed outside her vagina. The ulcer was a result of the friction between the uterus and her underwear. I reassured her that it was not cancer. However, to resolve her problem, I told her that her uterus had to be removed by surgery.
G was suffering from a gynaecological condition called uterine prolapse which is quite common after menopause when the pelvic muscles and ligaments which support the uterus are weakened from the falling levels of the female hormones. As a result, the uterus slips down and protrudes out of the vagina.
Women who have delivered many children or have given birth to big babies vaginally are more prone to this condition. Other risk factors include obesity, chronic constipation, repeated heavy lifting, previous pelvic surgery and a family history of weakness in connective tissue .
Symptoms of uterine prolapse vary. There may be no symptoms when the condition is mild. In severe cases like G’s, a large and uncomfortable lump will protrude outside the vagina. There may be urinary leakage (incontinence) or an inability to empty the bladder or bowel completely. The sensation of heaviness or pulling in the pelvis may also be present and the patient may feel “looseness” in the vagina during sexual intimacy .
In treating mild uterine prolapse, Kegel exercises to strengthen pelvic muscles usually suffice. But when the condition causes discomfort or disrupts normal activity, surgical removal of the uterus with repair of the weakened pelvic floor tissues is the treatment of choice. In patients who are not suitable for surgery, the use of a vaginal pessary, which is a plastic or rubber ring, can be inserted into the vagina to support the bulging tissues.
G accepted my advice and had a successful operation . After the wound had healed, I told her to do Kegel exercises regularly and to control her weight. She was also advised to avoid constipation and heavy lifting.