Prolapse of the Uterus

Etiology

Prolapse of the uterus is always due to Spleen-Qi or Kidney-Qi sinking and it therefore always occurs against a background of Spleen or Kidney deficiency. Some possible causes include:

• Excessive physical exercise or sports over a long period of time
• Excessive lifting over a long period of time
• Chronic illness
• Childbirth
• Prolonged coughing

Pathology

The pathology of prolapse of the uterus is always due to Qi deficiency and sinking: this may be Spleen-Qi, Kidney-Qi or both. It should be noted that a prolapse of the uterus can cause clinical manifestations even when it is very slight.

Identification of Patterns and Treatment

Symptoms of uterine prolapse include a feeling of bearing down in the lower abdomen and frequent urination. From an acupuncture perspective, apart from the Spleen and Kidneys, three Extraordinary Vessels are involved in the pathology of prolapse of the uterus: the Governing, Directing and Girdle Vessels. The Governing and Directing Vessels run along the midline of the body, one Yang, one Yin in nature. As the uterus is centrally located, a weakness of these two vessels may cause a prolapse. For this reason, a combination of Governing and Directing Vessel points is particularly effective to treat prolapse of the uterus, e.g. Du-20 Baihui and Ren-6 Qihai. The Girdle Vessel is also involved in prolapses because it is the belt that ‘binds’ the lower abdominal organs: when the belt is too slack, the organs sag and prolapses may occur. For this reason, points from the Girdle Vessel, such as G.B.-28 Weidao, are also used for uterine prolapse.

The patterns discussed are:

• Spleen-Qi sinking: clinical manifestations include prolapse of the uterus, a feeling of bearing down in the lower abdomen, tiredness, loose stools, poor appetite, depression. Tongue: Pale. Pulse: Weak. Treatment principle: tonify and raise Spleen-Qi.
• Kidney-Qi deficient and sinking: clinical manifestations include prolapse of the uterus, frequent urination, a bearing-down feeling in the lower abdomen, backache, depression. Tongue: Pale. Pulse: Deep, Weak. Treatment principle: tonify and raise Kidney-Qi.

Prognosis and Prevention

Both acupuncture and herbal medicine give good results in uterine prolapse. Often, acupuncture alone is enough. However, the prognosis depends on the degree of prolapse (see below). First-degree prolapse can be helped, second-degree prolapse is difficult to treat and third-degree prolapse will not respond to treatment. Women who have a very slight prolapse or who have been cured of a prolapse should pay great attention to not exercising too much and, in particular, to not running (jogging) or lifting. They should also make sure that they do not overwork and alternate work with periods of rest lying down.

Western View

Prolapse of the uterus develops as a result of weight-bearing during pregnancy and the trauma of delivery. The decrease in estrogen associated with the menopause is also a factor as this decrease causes a weakening of pelvic tissues. Prolapse of the uterus is classified in three degrees depending on the degree of herniation of the uterus:

• First degree: the cervix and upper part of the vagina protrude into the vaginal opening
• Second degree: the uterus protrudes outside the vagina, but not outside the labia
• Third degree: the uterus protrudes outside the labia

Treatment for uterine prolapse may include pelvic floor exercises, pessary devices, hormone therapy, or surgery. The choice of treatment depends on the degree of prolapse, the woman’s age and general health, and her preference.