Retroverted Uterus

The uterus is a hollow pear shaped organ. It is a region where the growth of developing foetus takes place. It is very small during non pregnant stage, but during pregnancy it becomes enlarged and visible, due to its immense elasticity. Normally uterus lies in straight vertical position, in line with the vagina. It is located in straight up and down position, inside of the pelvis. It tips slightly forward, towards the stomach.

Retroverted uterus

Retroverted uterus is tipped backward. It is tilted inside the pelvis. Uterus is tilted backward slightly towards the spine. Uterus aims towards the rectum, instead of lying forward towards the belly. It is also called tipped uterus, and affecting not more than 20% of women.

Symptoms of retroverted uterus

• Pain during sexual intercourse, mostly vaginal intercourse, dyspareunia.
• Pain during menstruation, dysmenorrhea
• Irregular ovulation and infertility.

Pain is caused due to the pressure which, retroverted uterus exerts on rectum and on ligaments around the tail bone.

Rare symptoms include:

• Lower back pain
• Incontinence
• More susceptible to urinary tract infections
• Pain while using tampons.

Causes of retroverted uterus

• Natural variation:

It is due to genetic makeup of women. Generally uterus occupies forward position as the women matures, But sometimes it remains backward.

• Adhesions:

It is a band of tissue, which connects the two anatomical different surfaces. Surgery of the pelvic region may cause adhesion and can lead the uterus in retroverted position.

• Fibroids:

These are non cancerous granules or lumps, which when found in human body can tip uterus in backward position.

• Endometriosis:

Endometrium is the lining of uterus by smooth muscles. It is highly fibrous and elastic structure. Endometriosis is the extension of smooth muscles uterine walls outside the uterus. This condition can be the primary cause of retroverted uterus. It attaches uterus to some other pelvic structures making it tipping backward.

• Pregnancy:

Bands of connective tissues, called ligaments keep tightly the uterus in its fixed position. Pregnancy can overstretch these ligaments and can tip uterus backward leading to retroverted uterus. Sometimes after child birth uterus can regain its normal position and sometimes it doesn’t. All these are natural processes and completely non predictable.

• Menopause:

During menopause there occurs a rapid fall in oestrogen level in ladies. These Causes ligaments to become loose and brings uterus into a retroverted position.

• Pelvic inflammatory disease:

It causes uterus to tilt backward. It causes scar formation inside the abdomen, thus dislocating uterus from its normal position.

Diagnosis:

If you are experiencing the problem of tipped uterus consultation to the physician is necessary. He can detect it through simple tests like pelvic examination, abdominal ultrasound.

Can a retroverted uterus prevent pregnancy?

Tipped uterus can only be the cause of infertility, if other reasons for infertility have been ruled out. Doctor might ask the woman to undergo certain tests such as uterine suspension and UPLIFT procedure if there are no other reasons for fertility problems. But it is very rare and quite uncommon. Usually between 10^th to 12^th weeks of pregnancy, uterus no longer remains retroverted might be due to overstretching of uterus. So it causes no troubles in pregnancy or labour or delivery of the baby. If uterus does not move to the central position,  miscarriage may occur but chances are very rare.

Treatment for a retroverted uterus

• Treatment for the underlying condition:

Injection of hormone from outside in case of endometriosis

• Pessary:

It is a small plastic or silicon device, placed inside, which supports uterus and helps it to bend in forward direction. By using pessary there can be chances of infection and inflammation, as it is a foreign body. It is still painful for the women during sexual intercourse and also causes discomfort to her partner.

• Surgery:

Using laproscope, uterus can be again repositioned so that it fits over the bladder. This operation is mostly fruitful. Sometimes there occurs permanent removal of the bladder.

Exercises

If tipped uterus is not due to endometriosis or fibroids and if the doctor can reset the uterus by simple pelvis examination then exercises are much helpful.

• Kegal exercises:

Kegal exercises strengthen the weaken ligament muscle and reposition uterus by tipping it forward. By inserting finger in vagina you can feel the pelvic floor. Contract the muscle surrounding the inserted finger. If done properly you will feel your pelvic floor muscle move upward in each contraction. After relaxing the contraction, pelvic floor muscle moves downward. This alternate contraction and relaxation should be repeated daily to reposition the uterus.

• Knee to chest exercise:

Lie backward on a flat surface. Bend both knees and foot placed firmly on the floor. Bring right foot to the chest without disturbing the left foot. Be in this position for 15 to 30 sec. Then return to original position. 10 times this process should be repeated with both legs, thrice daily. It will help to rectify the retroverted position of uterus.