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Hello Doctor,I'm a 28yr. old medical graduate myself.I've a son-2yrs.& 7 months old,I had an elective ,induced vaginal delivery which was posted a week before my due delivery date,on grounds of a probable postdated delivery by the obstetrician/gyn. i was induced with prostaglandin gel and a dose of oxytocin.at around 12 midnite, my first stage lasted for only abt 8 hrs. and delivered by 8am. the following morning vaginally.My Last menstrual period was on the 8th. of April this month.I saw the same gyneac recently for the foll. symptoms from the past 8-9 months , for premenstrual spotting which continued into an actual mild bleeding with a brown -red discharge during the time and after my ovulation,which again got into continuation with my regular menstruation.i suffured additionally from backache ,dysmenorrea ,menorrhagia & bloodclots in the recent months too.During my last menstruation i.e. from april 8th.I had severe backache and dysmenorrea, fatigue & sciatica like symptoms for which i took the consultation.,after an examination.the doctor appraised me abt. a first degree uterine descent & relaxed uterine ligaments- an extra worry in addition to my premenstrual bleeding .The doc. advised me some exercises and iron supplimentation,and Norethindrone-5 mg ,until a week before my next menses and to withdraw there after-the tablet which i'm taking right now.This is my history. My
question is could my 1st. degree uterine(prolapse) be a consequence of my induced delivery which dint last longer and the powerful uterine contractions during my delivery. Also what are its effects on my future pregnancies and sex.I wud appreciate your inputand advise.thank you very mush for u'r patient reading.-Ahana
Answer -
Pelvic organ prolapse can be caused by several factors. The intrinsic strength of the connective tissue and muscles of the pelvic floor in a given individual, damage that mnay occur to these structures during childbirth, deterioration with age, and stresses that they are subjected to over the course of a lifetime play a role in the development of pelvic organ prolapse. Heavy lifting, obesity, chronic coughing can also cause prolapse. Some women even have a predisposition due to genetic reasons. Often we see prolapse after vaginal deliveries where there was lots of pressure during the second phase of labor (from full dilatation to delivery). Sometimes, an extension of an episiotomy can cause a weakening of the pelvic floor and this can cause a pulling of the cardinal ligaments holding the uterus in place.
--Follow Up Questions ---Is it possible to reverse the stage 1 prolapse with exercises?
what about future pregnancy-will it cause problems- because my retroverted pregnant uterus can impact sometimes.
will it affect fertility?
what are the treatment options at my age of 27 years-surgical included.?
-Thank You -Ahana
AnswerIn the early stages of type I uterine prolapse with a cystocele, you can try Kegel's exercises, which tend to help strengthen the area betweent the bladder and the vagina. They are done by tigntening your muscles as if you are trying not to urinate. Tighten and relax. Tighten and relax. Continue this for around 20 times in rapid succession. This can be done several times a day and can be done while you are walking or sitting around. Nobody else will know if you are doing these exercises while you are doing them. If you become pregnant, the uterus will usually straighten out and hold itself up, but there may be a problem if there is progression to a type II or III prolapse. It will not affect fertility. YOu can still conceive normally and can engage in normal sexual activity. The only treatment options are surgery (the best at your age) or a pessary (a devise that holds up your uterus and has to be cleaned every two weeks). Surgery includes a "sling operation" which holds the uterus up (like a hammock) or a hysterectomy (which, of course, will end your fertility and child bearing capeabilities.). Good Luck to you. I think you should sit down with your gynecologist and discuss all of this at a meeting scheduled just for this.,
