round ligaments and anteversion of retroverted uterus

Submitted by louiseds on October 1, 2012 - 7:57pm
Body: 

Christine, thanks for the Hysterectomy post in your blog, The village Post.

There is a diagram in it showing the round ligaments.

My uterus was retroverted from the time I started using tampons, aged about fifteen. About three years before menopause, and several years after starting WW work I realised one day that my uterus was no longer retroverted. At last my cervix was coming out of the front wall instead of the back wall, which was my indication.

The lightbulb came on when I saw the diagram. As I approached menopause my uterus became smaller and smaller. As the fundus shrank back towards the cervix it would pull on the round ligaments. Eventually the reduction in length from cervix to fundus would have been great enough to pull the whole uterus forwards to normal presentation. This would also be true for a woman who normally has an anteverted uterus. So I conclude that post menopause all women with a uterus will have round ligaments that are more functional, ie they have more of a role in pulling the uterus (and bladder) forwards.

Maybe this is part of the reason for the shrinkage of the labia at menopause? Maybe the round ligaments are pulled up tight under the mons and pubic bones instead of hanging loosely in the labia, and so the labia no longer hang down? The vulva is no longer loose and is probably less mobile during penetrative sex, which may be another factor in vulval irritation from sex after menopause.

TMI coming up. Perhaps post-menopause women are designed to not have penetrative sex? No chance of pregnancy, and it doesn't feel as nice, so what's the point?????

Back to your diagram ... I can now see a whole circle of taut tissue in that diagram. It starts at the vulva, incorporates the vaginal walls, the cervix, the body of the uterus up its side to the horns, where the round ligaments join the uterus. The round ligaments take up the tautness and go forwards, over the front of the pubic bones and back where they are embedded right into the labia, overlapping the vulva (which has to be in tension), where the circle is completed.

Inside this circle sits the bladder. As the bladder fills it will tighten the circle more. As long as the woman has a relaxed lower belly, some volume of urine in her bladder will help to lengthen her vagina and support her prolapses. Therefore, frequent urination, which keeps the bladder nearly empty is not supportive of pelvic organ prolapse. Filling your bladder to capacity on a daily basis may be as important as emptying it completely on a daily basis.

Christine, your comments please?

Louise

Forum:

curiousity

October 2, 2012 - 12:47am

I reckon this would depend on where the uterus was in relation to the bladder. If the uterus is behind/below the bladder then wouldn't a full bladder push it further back/down? But I think you are right if you do not have primary uterine prolapse, and in fact I have felt this, sometimes after emptying my bladder, my POP feels floppy and worse.

louiseds

October 2, 2012 - 2:08am

Whether the uterus is behind or below the bladder will largely depend on our posture, but of course when you have POP positioning is never ideal.

From the front of the body the order is always bladder at the front, vagina-cervix-uterus in the middle (with the uterus furthest from the vulva, and the rectum at the back.

Whole woman posture changes this to pubic bones at the bottom, then going up there is the bladder and ideally the uterus folding over the top of the bladder, and the rectum longer and coming up and forward at the top, towards the cervix.

I think the uterus kind of flops around to wherever it is pushed by the intestines if the pelvis is tilted back and the lumbar curve is absent. Put a strong lumbar curve into the system and it will push the uterus forwards over the bladder.

The degree to which a woman can normalise this latter arrangement will determine how well she can support her pelvic organs.

If the uterus is under the bladder, the bladder *will* push the uterus downwards. The aim of WW posture is to reverse this by getting the uterus back to where it should be. I think the round ligaments will always attempt to restore this normal arrangement.

Curiosity, have you tried firebreathing and nauli, or even my jiggling, after emptying your bladder, and before you pull up your undies, to try and restore the proper positioning before the uterus decides to slide back down into the space left by the fullness of the bladder? I don't know how this would work, but I am curious about it.

What better person than Curiosity to try it?

Louise

curiousity

October 2, 2012 - 3:06am

I shall report back :-)

Christine

October 2, 2012 - 11:32am

This is a wonderful study, Louise, and one of the subjects I am keenly interested in.

Embryologically, the round ligaments are analogous to the spermatic cords in men. The spermatic cords are thick, ropey structures that pull the testes into the scrotum in late fetal stage. They do this by contracting. I'm sure they are also what keep the testes descended - probably by contracting with each orgasm.

Not surprisingly, the round ligaments are made of the same contractile muscle tissue as the uterus itself. None of the other connective structures - including the uterosacral "ligaments" have this contractile quality. This means they are "condensations of fascia", which is how the surgeons describe them. They would respond primarily to nutrition, not posture. It is the round ligaments we are really concerned with - the same round ligaments that are omitted and scorned as having "no supportive value". LOL.

Believe me, I have wondered for years what might cause the round ligaments to contract. Certainly orgasm would...and oxytocin, the "love hormone". From my perspective the uterus is better able to pull forward after menopause because the round ligaments shrink along with the uterus. The reason WW posture and exercise is so essential to pelvic organ support is because it lengthens the reach of the round ligaments, positioning the labia higher in back.

The exercise I do in FAFP where I stand in WWPosture, over-cross my feet and lean back is specifically addressing the pull of the round ligaments. You might remember this was copied by the idiot urogynecologist on the Dr. Oz prolapse show. She had people in the audience stand, cross their feet and do a kegel. sigh.

I don't believe using a full bladder as pessary is a good idea. The bladder likes to be emptied - sooner rather than later, imho.

Just as a side note...I had 2 wombed women and 1 post-hysterectomy woman in class today. The musculoskeletal collapse is breathtaking - particularly if the uterus was removed early in the reproductive years. This subject has never been studied by either gynecology or orthopedics - an utter travesty.

Christine

Surviving60

October 2, 2012 - 4:29pm

Well, are my instincts good, or what? That move was the first one I grabbed on to after my very first viewing of FAFP. I still do it practically every morning in the shower. I love my round ligaments!! - Surviving

Christine

October 2, 2012 - 4:38pm

You are remarkably brilliant, Surviving...and I mean that truly.

curiousity

October 2, 2012 - 6:32pm

Ok, this is what I did: measured where my cervix was with a full bladder (with a handy little dildo I have :-)), then emptied my bladder and measured again. So my cervix was in the same place before and after, high up in my vagina. (But I don't have significant UP). So for me the theory is not holding up (so to speak). I wonder whether the loose feeling I sometimes get after urinating is the floppiness of the anterior wall, which is stretched taut with a full bladder.

louiseds

October 2, 2012 - 7:54pm

Thanks for doing the experiment, Curiosity. Your explanation sounds feasible. The bladder wall is, of course, tethered to the front vaginal wall. Every organ affects the others. And when I said the 'space' will be filled, I didn't mean it literally. There is no actual space left when the bladder empties, but there will be looseness where previously there was firmness or pressure. I wonder what filled the volume left by the distended bladder? What moved into that space? The dildo, being solid, would have acted like a pillar in the middle, and maybe changed the way the pelvic contents moved after urination. Interesting. It is so complicated in that little cave of ours.

Christine, I don't mean that is is good to keep your bladder full all the time. I mean that *frequent* urination will not help proper pelvic organ positioning. I simply mean that it is good to let your bladder fill and use its space, then empty it. Pelvic organ configuration is designed to accommodate distension, isn't it? The bladder may inadvertently act as a pessary for a while when it is full but as it fills with the uterus on top of it, it will lengthen the vagina by moving the cervix up with it.

As a post-menopause woman I can sit for hours without the urge to urinate. I now make myself go to the toilet if I feel the slightest fullness twinge a couple of hours after the previous toilet visit.

I can only conclude that full distension and complete emptying of the bladder should both be features in the life of the healthy pelvis, the same way as using all our muscles through their full range of movement.

Louise