QUESTIONS FROM READERS:PROLAPSE OF THE WOMB

Q:In common with many women of my age ( I am 68) I suffer from a vaginal prolapse. When this condition first occurred some six years ago, my gynaecologist fitted a support ring without giving me any instructions as to how to manage it or suggesting

About a year ago it did worsen to what I believe is known as the second stage, during periods of general debility such as stress, heavy colds or flu. I am told that I should now have a hysterectomy as this is the only way to deal with the condition.

I am reluctant to take that step, as apart from the discomfort of the prolapse, I lead a fairly active normal life (walking my dog each day and horse riding about once a week) and enjoy fairly good general health. I fear that the debilitating experience of a major operation would not improve my general health and quality of life.

I should be grateful if you could advise me as to what steps I might take, and let me know if it would be possible to consult a gynaecologist who specializes in medical rather than surgical procedures. S T, Wells………

!BA:Uterine prolapse is a fancy term for a condition in which your uterus falls out of its proper place. It occurs when the ligaments that support the uterus or the pubococcygeal muscle supporting the pelvic floor have stretched. As you mentioned, medicine has defined uterine prolapse in three stages:

In the first degree the uterus has descended into the vaginal canal, but not into the opening. Prolapse is considered second degree when the uterus fills the vaginal canal. In the third degree, the cervix actually shows outside the vagina.

This is the most serious stage because the cervix is unprotected and can become infected when exposed to urination and defecation.

In making its descent, the uterus doesn’t necessarily fall in a straight line. It can descend forward, pressing on your bladder, or backward, pushing on your bowel and rectum. If it does, this constant pressure can cause these organs to prolapse as well.

The usual symptoms of prolapse in the early stages are an occasional feeling of “bearing down”, or feeling that something is falling out of you. You can also feel lower back pressure or heaviness in your abdomen, achiness like mild menstrual cramps, a frequent need or urge to urinate, constipation, and of course difficulty in penetration during intercourse.

Your doctor was remiss in handing you your pessary without instructions. This rubber doughnut shaped device can help women in the first stages of prolapse avoid surgery by holding the uterus in place. However, the pessary should be fitted and inserted by a doctor. It also should be removed periodically every few months for cleaning. Before you consider surgery, it’s worth having another go with a pessary to see if it will hold your uterus in position. You might request referral to a consultant gynaecologist who is experienced in using a pessary and who can put it properly into place. These contraptions also come in different sizes, so if a smaller one didn’t work for you you can try a larger one.

Many writers, including those in the Boston Women’s Health Book Collective, who wrote Our Bodies, Ourselves, postulate that inadequate nutrition may have to do with the body losing muscle tone, collagen and elastin in the tissue and hormones.

One approach is to increase your intake of a variety of nutrients, including magnesium and calcium, which besides keeping your bones healthy, may contribute to better muscle tone. Soy products, which increase the natural oestrogen in your body, might also improve tissue tone. The Boston collective also believes that pelvic floor exercises can help improve prolapse, no matter how severe. It might also be a good idea to switch your form of exercise from horseback riding to something like swimming or walking which puts less strain on your internal ligaments.

If none of the above helps, get hold of Dr Vicki Hufnagel’s No More Hysterectomies (Thorsons) mentioned in the last letter. This excellent book was written by a gynaecologist who was appalled by the number of unnecessary hysterectomies. (Uterine prolapse accounts for a third of them.) Dr Hufnagel argues that since there is nothing wrong with the uterus in a prolapse, there is no justification for taking it out.

A less drastic measure is uterine suspension surgery. This abdominal surgery lifts the uterus back into its correct position by shortening the overstretched ligaments holding the uterus in place. This form of surgery is far less drastic; you’re expected to recover and get back to normal activity within four to six days. However, there is no certainty here in 20 per cent of cases, it won’t correct the problem and prolapse could recur.