Dr. Manisha Jagtap

The uterus is set up inside the pelvis with different muscles, tissue, and tendons. Due to pregnancy, labour or complicated delivery, in a few ladies, these muscles tend to weaken. Additionally, as a woman ages and with a loss of the hormone oestrogen, her uterus can drop into the vaginal canal, bringing about the condition known as a uterine prolapse.

The following conditions can bring about a prolapsed uterus:

1. Pregnancy with complicated or even ordinary delivery through the vagina.
2. Weakness in the pelvic muscles with the increase in age.
3. Weakening and loss of tissue after menopause and loss of normal oestrogen.
4. Conditions leading to increased weight in the abdomen, for example, constant coughing (with bronchitis and asthma), straining along with constipation, pelvic tumours (uncommon), or clogging of liquid in the abdomen.
5. Being overweight puts extra strain on pelvic muscles.
6. Previous surgery in the pelvic region leading to loss of outer support
7. Smoking

However, this condition can be treated effectively:

1. Self care at Home: You can strengthen your pelvic muscles by performing Kegel workouts. You do these by contracting your pelvic muscles, as though attempting to stop the stream of urine. This exercise makes the pelvic muscle strong and gives some support. Have your specialist train you on the best possible approaches to exercise your muscles.
2. Medications: Oestrogen (a hormone) cream or suppository ovules or rings embedded into the vagina help in strength and endurance building of the tissues in the vagina. However, oestrogen is just for use in some of the postmenopausal ladies.
3. Surgery: Based on your age and whether you wish to conceive a child naturally, surgery can repair the uterus or remove it. The uterus as in many cases can be expelled with a hysterectomy. During the surgery, the specialist can repair the hanging or saggy vaginal dividers, urethra, bladder, or rectum. The surgery might be performed by an open abdomen procedure, through the vagina, or through little cuts in the abdomen or vagina with particular instruments.
4. Other Therapy: In case that you do not need surgery or have a poor possibility for surgery, you may choose to wear a steady gadget, called a pessary. It is worn in the vaginal tract to strengthen the falling uterus. It can be utilised briefly or can be long-lasting. They come in different shapes and sizes and should be fitted according to the person. In case that the prolapse is extreme, a pessary may not work. Prolapse surgery is always preferred by vaginal route. Likewise, pessaries can disturb the insides of the vagina and may bring about a noxious release.

It can be prevented in the following manner:

1. Decrease your weight.
2. Try to avoid constipation by consuming a high-fiber diet.
3. Do Kegel exercises to strengthen the pelvic muscles.
4. Stay away from heavy lifting or straining.

In case you have a concern or query you can always consult an expert & get answers to your questions!

The symptoms caused due to herniated disc can be very severe and can also cause a bit of disability. The disc of the spine is like a cushion and separates the set of bones on the backside. The discs are shock absorbers of the spine and are mainly composed of 2 parts, a soft jelly centre called the nucleus and a tough outer covering called the annulus.

Effects of Herniated Disk
A herniated or cracked disc is a severe condition and it seems to happen most commonly in the lower back.  It happens when a fraction of the soft centre gets pushed through the destabilized area due to degeneration, trauma or by putting pressure on the spinal cord. 

Nerves are located precisely at the back of every disc and are responsible for controlling everything in our body. While a disc gets herniated, the external covering of the disc tears and creates a bulge. The soft jelly gets shifted from the centre of the disk to the region where the damage has occurred on the disc. Most commonly, the bulge occurs in areas where the nerve is located and it causes strain on the affected nerve. It has been observed that individuals do not feel any painful sensations even if their disc gets damaged.

When is Surgery Recommended for Herniated Disc?
Surgery for herniated disc is recommended only after options like steroid injections, pain relievers, exercise and non-steroid anti-inflammatory drugs do not work. If the pain persists even after these options, then it becomes important to go for surgery. There are certain risks involved in this surgery like infection, bleeding or nerve damage. 

There are chances that the disc may get ruptured again if it is not removed. If you are a patient suffering from degenerative disc disease, then there are chances that problem occurs in other discs. It is very important that a patient maintains healthy weight to prevent any further complications.

The main factor that increases the risk of herniated disc is excess body weight, which causes a lot of stress on the lower back. A few people become heir to a tendency of developing this condition. Even individuals with physically demanding jobs are prone to this condition. 

Activities like bending sideways, pushing, twisting, repetitive lifting can increase the risk of a herniated disk. At times, emergency surgery is also required to avoid paralysis in a patient. If you wish to discuss about any specific problem, you can consult an orthopedist.

A mastectomy is surgical removal of a breast. The surgery depends on various factors and choosing a type of mastectomy best suited for an individual suffering from breast cancer requires experience and expertise. With advancing technology, there are more options available for women to opt for surgeries, which are minimally invasive and conserving in nature. Following are the various types of mastectomies and the factors, which influence them:

Types of Mastectomy

1. Total or simple mastectomy

This is a surgical procedure which involves complete removal of the breast including the nipple. The lymph nodes, which are small glands, are an important part of your immune system and are kept intact during the surgery. This form of surgery is most suitable if the cancer has not spread to the lymph nodes.

2. Preventive mastectomy

Preventive mastectomy, also known as prophylactic mastectomy, is an option for women who have a high risk of developing breast cancer. Preventive mastectomy reduces the risk of breast cancer by a huge margin. In certain cases, removal of the entire breast along with the nipple is advisable. Women who develop cancer on one breast often opt for preventive mastectomy and remove the other unaffected breast as well.

3. Partial mastectomy

Women who are in stage I or stage ii of breast cancer can choose this procedure. It is a breast conserving technique where the tumor is removed along with the tissue that surrounds it. It is followed up by radiation therapy on the remaining breast tissue, which terminates the cancer cells and stops them from spreading. There are two types of partial mastectomy, namely, lumpectomy and quadrantectomy.

4. Radical mastectomy

Although this procedure is almost out of use, it is still considered in case the cancer has spread to certain areas like the chest muscle. In this form of surgery, the breast is removed entirety along with muscles beneath it and the lymph nodes.

5. Modified mastectomy

It is a more commonly used procedure characterized by complete removal of the breast including underarm lymph nodes. The chest muscles are untouched in the procedure, therefore allowing a breast reconstruction to follow.

Factors influencing the type of mastectomy:

• Age of the individual

• Health in general

• Size of the tumor

• The spread of the tumor

• The rate of progression of the tumor

• Whether lymph nodes are affected or not 

If you wish to discuss about any specific problem, you can consult a doctor.

Breast cancer is an abnormal growth of cells in the tissues of the breast. Mainly it occurs in females but less than 1% of all the breast cancer cases develop in males. The majority of breast cancers start in the milk ducts. A small number start in the milk sacs or lobules. It can spread to the lymph nodes and to the other parts of the body such as bones, liver, lungs and to the brain.

With more reliable early detection methods as well as the trend towards less invasive surgery, there is hope that even more women with breast cancer will be treated successfully and will go on to resume their normal lives.

Signs & Symptoms 
It is painless, especially, during the early stage. Watch out for the following changes in the breast:

1. A persistent lump or thickening in the breast or in the axilla. 
2. A change in the size or shape of the breast. 
3. A change in the colour or appearance of the skin of the breast such as redness, puckering or dimpling. 
4. Bloody discharge from the nipple. 
5. A change in the nipple or areola such as scaliness, persistent rash or nipple retraction (nipple pulled into the breast).

Consult a doctor immediately if you notice any of these changes.

Risk Factors 
Being a woman puts you at risk of getting breast cancer. There are certain factors that increase the risk of breast cancer. Some of them have been listed below:

1. The risk increases with age; most cases of breast cancer develop after the age of 50 
2. Genetic alterations in certain genes such as BRCA1 and BRCA2 
3. Family history of breast cancer 
4. Being overweight 
5. Early menarche (onset of menstruation before the age of 12) 
6. Late menopause (after the age of 55) 
7. Never had children 
8. Late childbearing 
9. No breast feeding 
10. Excessive consumption of alcohol 
11. Use of hormonal replacement therapy (HRT) for a long period of time

However, most women who have breast cancer have none of the above risk factors. Likewise, not having any of these risk factors does not mean that you will not get breast cancer.

Early Detection and Screening

More treatment options are available when breast cancer is diagnosed at an early stage and hence the chances of recovery is also higher. So regular breast screening is important for early detection even if there are no symptoms. Following are the ways of screening:

1. Breast Self-Examination (BSE): Perform BSE once a month about a week after your menses are over. If you no longer menstruate, choose a date each month which is easy to remember e.g. your date of birth or anniversary.
2. Clinical Breast Examination: Get a breast specialist to examine your breast once a year if you are 40 years and above.
3. Mammogram: Go for a screening mammogram once a year if you are 40 to 49 years old and once every two years if you are 50 years and above even if you do not have any symptom. It is not recommended for younger women (less than 40 years of age) as they have dense breasts, making it difficult for small changes to be detected on a mammogram. So ultrasonography of the breasts is advisable to them.

Types of Breast cancer

1. Non-Invasive Breast cancer: These are confined to the ducts within the breasts. They are known as Ductal carcinoma in-situ (DCIS).
2. Invasive Breast cancer: It occurs when cancer cells spread beyond the ducts or lobules. Cancer cells first spread to the surrounding breast tissue and subsequently to the lymph nodes in the armpit (Axillary lymph nodes). These cells can also travel to the other parts of the body such as bones, liver, lungs or brain and hence known as metastatic breast cancer.

Making A Diagnosis 

If you notice any unusual changes in your breasts, you should see a doctor immediately. He will examine you clinically and may ask you to undergo some tests so that a definitive diagnosis can be made. Further, the staging work up is done to find out the stage of the disease and management accordingly.

Treatment options 
Treatment of breast cancer may include various methods such as surgery with or without breast reconstruction, chemotherapy, radiation therapy, hormonal therapy and targeted therapy. Treatment options offered, depend upon the number of factors such as the stage of cancer and likelihood of cure, your general health and your preference. If you wish to discuss about any specific problem, you can consult an oncologist.