Uterine Diseases




Abnormal Uterine Bleeding

In many women, a hormone imbalance, such as too much estrogen or not enough progesterone, causes abnormal uterine bleeding. Polyps or fibroids (small and large growths) in the uterus can also cause bleeding as well as cancer of the uterus and infection of the cervix. Sometimes a thyroid problem causes bleeding.

These are just a few of the problems that can cause abnormal uterine bleeding. These problems can occur at any age, but the likely cause of abnormal uterine bleeding depends on your age.

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Adenomyosis

Adenomyosis isn't the same as endometriosis, a condition in which the uterine lining becomes implanted outside the uterus. Although the cause of adenomyosis remains unknown, the disease typically disappears after menopause. For women who experience severe discomfort from adenomyosis, there are treatments that can help, but hysterectomy is the only cure.

With adenomyosis, the tissue that lines the uterus (endometrium) grows within the uterus' muscular outer walls. This is most likely to happen late in your childbearing years and after you've had children.

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Cervicitis

Cervicitis is an inflammation of the cervix, the lower, narrow end of your uterus that opens into your vagina. Most cases of cervicitis are caused by infection with sexually transmitted diseases, including gonorrhea and chlamydia.

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Double uterus

In a female fetus, the uterus starts out as two small tubes. As the fetus develops, the tubes normally join to create one larger, hollow organ - the uterus. Sometimes, however, the tubes don't join completely. Instead, each one develops into a separate cavity. This condition is called double uterus (uterus didelphys).

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Endometrial Hyperplasia

Endometrial hyperplasia is a condition that occurs when the lining of the uterus (endometrium) grows too much. It is a benign (not cancer) condition.

Uterine polyps

Uterine (endometrial) polyps consist of areas in your uterus where the lining of the uterus (endometrium) becomes overgrown and forms a mass (polyp). Uterine polyps may attach to the interior of your uterus by a large base or a thin stalk and range in size from a few millimeters - the size of a sesame seed - to several centimeters - the size of a golf ball or larger.

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Vesicoureteral Reflux

Urine normally flows in one direction-down from the kidneys, through tubes called ureters, to the bladder. Vesicoureteral reflux (VUR) is the abnormal flow of urine from the bladder back into the ureters.

VUR is most commonly diagnosed in infancy and childhood after the patient has a urinary tract infection (UTI). About one-third of children with a UTI are found to have VUR. VUR can lead to infection because urine that remains in the child’s urinary tract provides a place for bacteria to grow. But sometimes the infection itself is the cause of VUR.

There are two types of VUR. Primary VUR occurs when a child is born with an impaired valve where the ureter joins the bladder. This happens if the ureter did not grow long enough during the child's development in the womb. The valve does not close properly, so urine backs up (refluxes) from the bladder to the ureters, and eventually to the kidneys. This type of VUR can get better or disappear as the child gets older. The ureter gets longer as the child grows, and the function of the valve improves.

Secondary VUR occurs when there is a blockage anywhere in the urinary system. The blockage may be caused by an infection in the bladder that leads to swelling of the ureter. This also causes a reflux of urine to the kidneys. Infection is the most common symptom of VUR. As the child gets older, other symptoms, such as bedwetting, high blood pressure, protein in the urine, and kidney failure, may appear.

Common tests to show the presence of a urinary tract infection include urine analysis and cultures. Because no single test can tell everything about the urinary tract that might be important to know, more than one of the following imaging tests may be needed:
  • Kidney and bladder ultrasound: A test that uses sound waves to examine the kidney and bladder. This test shows shadows of the kidney and bladder that may point out certain abnormalities. The test cannot reveal all important urinary abnormalities or measure how well a kidney works.
  • Voiding cystourethrogram (VCUG): A test that examines the urethra and bladder while the bladder fills and empties. A liquid that can be seen on x rays is placed in the bladder through a catheter. Pictures are taken when the bladder is filled and when the child urinates. This test can reveal abnormalities of the inside of the urethra and bladder. The test can also determine whether the flow of urine is normal when the bladder empties.
  • Intravenous pyelogram: A test that examines the whole urinary tract. A liquid that can be seen on x rays is injected into a vein. The substance travels into the kidneys and bladder, revealing possible obstructions.
  • Nuclear scans: A number of tests using radioactive materials that are usually injected into a vein to show how well the kidneys work, their shape, and whether urine empties from the kidneys normally. Each kind of nuclear scan gives different information about the kidneys and bladder. Nuclear scans expose a child to about the same amount of radiation as a conventional x-ray. At times, it can be even less.
The goal for treatment of VUR is to prevent any kidney damage from occurring. Infections should be treated at once with antibiotics to prevent the infection from moving into the kidneys. Antibiotic therapy usually corrects reflux caused by infection. Sometimes surgery is needed to correct primary VUR.

Surgery is considered only when severe reflux has caused infection that can't be controlled with antibiotics. The most common procedure to correct VUR is to sever the ureter from the bladder and then reattach it at a different angle so that urine can't back up. In recent years, doctors have treated some cases of VUR by injecting a bulking agent into the bladder wall around the opening of the ureter where reflux happens.

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Uterine prolapse

Uterine prolapse means your uterus has dropped from its position within the pelvis into your vagina. Normally, your uterus is held in place by the muscles and ligaments that make up your pelvic floor. Uterine prolapse results when pelvic floor muscles and ligaments weaken, providing inadequate support for the uterus. The uterus then descends into the vaginal canal.

Uterine prolapse most often affects postmenopausal women who've had one or more vaginal deliveries. Damage to supportive tissues incurred during pregnancy and childbirth plus the effects of gravity, loss of estrogen and repeated straining over the years can weaken pelvic floor muscles and lead to prolapse.

If you experience only mild uterine prolapse, treatment usually isn't needed. But if you experience discomfort or interruption of your lifestyle as a result of uterine prolapse, you might benefit from surgery to repair the prolapse, or you may elect to use a special supportive device (pessary), which is inserted into your vagina.

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Signs and Symptoms

Cystoscopy and Ureteroscopy

When you have a urinary problem, your doctor may use a cystoscope to see inside your bladder and urethra. The urethra is the tube that carries urine from the bladder to the outside of the body. The cystoscope has lenses like a telescope or microscope. These lenses let the doctor focus on the inner surfaces of the urinary tract. Some cystoscopes use optical fibers (flexible glass fibers) that carry an image from the tip of the instrument to a viewing piece at the other end. The cystoscope is as thin as a pencil and has a light at the tip. Many cystoscopes have extra tubes to guide other instruments for procedures to treat urinary problems.

Your doctor may recommend cystoscopy for any of the following conditions:
  • frequent urinary tract infections
  • blood in your urine (hematuria)
  • loss of bladder control (incontinence) or overactive bladder
  • unusual cells found in urine sample
  • need for a bladder catheter
  • painful urination, chronic pelvic pain, or interstitial cystitis
  • urinary blockage such as prostate enlargement, stricture, or narrowing of the urinary tract
  • stone in the urinary tract
  • unusual growth, polyp, tumor, or cancer
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Information obtained from National Institute of Health
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