Womb Position Can Determine Your Health

If you’ve ever experienced a postnatal massage by an Indonesian or Malay practitioner, you may be familiar with the term “your uterus is hanging low,” or, “your womb is laying too low”. In Malay language, they call it “peranakan jatuh”. Being able to read and write in the Malay language, I am grateful to be able to research on the little literature there is available, and talk to many wonderful and humble Malay traditional postnatal care practitioners

It is common for Malay or Indonesian masseurs to correct the positioning of the womb for a women’s wellness, for the Malays believe the womb is a woman’s core and her outward beauty is a reflection of the condition of her womb. In South East Asia, “No cold drinks” and “No lifting of heavy objects” are common words of advice given by our grandmothers and mothers, believed to maintain womb health and wellbeing.

So what really does it mean to have a “low hanging uterus or womb”?

When I first studied Malay postnatal massage, be it in a university setting, in a modern spa or via traditional Malay masseurs, I was taught the position of the womb and how to massage – yet many of my questions on anatomy were never convincingly answered.

However, when I studied The Arvigo Techniques of Maya Abdominal Therapy® by Dr Rosita Arvigo, I realised how similar these two cultures are in terms of correcting womb positioning, and exactly how a misaligned uterus affects our health. Dr Arvigo has derived her specific therapy technique to help reposition reproductive organs and improve blood flow to digestive organs using an external, non-invasive hand manipulation method.

Here I’d like to share what I learnt and explain what it means when you are told that your uterus (or womb) has “dropped”.

A uterine prolapse is commonly known medically and refers to a condition when the uterus slips down into the vagina. A hollow, muscular organ roughly the size of a fist in a non-pregnant state, the uterus is suspended in the pelvis by fourteen ligaments and connective tissue and supported by the pelvic floor muscles. It is positioned in the lower medial pelvis, slightly above the bladder and in front of the colon, which allows for maximum circulation of arterial blood, nerve supply from the spinal column, exiting venous blood and lymphatic drainage.

The uterus is connected to the vagina by the cervix in a continuous flow of tissue.

Prolapse occurs when the pelvic floor muscles and ligaments are stretched and weaken, no longer providing adequate support for the uterus, which slips down into or protrudes out of the vagina.

Potential causes of uterine prolapse include:

• Damage to supportive tissues during pregnancy and childbirth
• The effects of gravity over time
• Loss of oestrogen as the woman matures
• Repeated straining over the years

The uterus can also slip out of place because ligaments and connective tissue are subject to lengthening and shortening and occasionally become distorted or inelastic. A displaced uterus can also be referred to as the following:

• Tilted uterus or tilted womb
• Retroflexed uterus
• Retroverted uterus
• Anteflexed uterus

The Arvigo Techniques of Maya Abdominal Therapy® teach that proper knowledge and application of repositioning techniques helps them to heal. So why does it matter to know the condition of our womb?

Following are some common symptoms of a displaced uterus:

1. Menstrual problems – painful periods; late, early or irregular periods; unusually dark, thick blood at the onset or end of menstruation; related headaches or migraine
2. Urinary issues – frequent urination, bladder infections and incontinence
3. Ovulatory symptoms – irregular or painful ovulation
4. Musculoskeletal indications – low backache, sore heels when walking

What causes these conditions? According to Dr Arvigo, the main reasons are:

1. Repeated pregnancies close together with difficult deliveries

When pregnancies occur close together, there is insufficient time for the length and strength of uterine ligaments to normalise before the next baby is conceived, especially in the case of large babies or complicated deliveries.

2. Undue pressure is placed on the uterus during pregnancy, birth and postpartum

The abdominal organs above the uterus can weigh up to 40-60lbs. When a woman lifts a heavy object, the diaphragm places downward pressure on her abdominal organs. The pelvic floor muscles (which have experienced recent strain during childbirth) may be unable to withstand further pressure and weight from above. This often results in a uterine prolapse. Carrying heavy objects may also harm the uterine ligaments and muscular wall, which takes time to heal. The Mayans believes in wearing a “faja” (abdominal wrap or postnatal corset) and similarly the Malays wear a “bengkung” – both are made of cloth and support the uterus until the ligaments have time to heal and revert back into their proper position and length.

The above picture shows a stretched Round Ligament, Broad Ligament and Uterosacral Ligament, connecting the uterus to the pelvis and sacrum. (Source: The Growing Uterus Chart: 40 weeks pregnant at term picture.)

Additionally, Dr Arvigo also lists the following as potential causes for a displaced uterus:

• Scarring from adhesions as a result of endometriosis or fibroids
• Injury to sacrum or tailbone from a fall or accident
• Wearing high-heeled shoes
• Running on cement surfaces; high-impact dancing, aerobics or sports
• Chronic cough
• The aging process

Similarly, the Malays believe the uterus needs to be returned to its original position following childbirth to prevent prolapse and side effects such as incontinence. The sixty-day period following delivery is the recommended timeframe to care for the uterus to allow it to heal and return to its pre-pregnancy size and position, especially given the fact that the relaxin hormone is still naturally present in the body during this time.

Karen Loke, Founder and Practitioner, Restoring Mums如果妳曾經進行由印尼或馬來人主理的產後按摩，妳會知道甚麼叫「子宮下垂」。在馬來語中，它被稱為「peranakan jatuh」。我能夠讀寫馬來語，因此我很高興可以研究現存極少部分可用的文獻，以及與很多經驗豐富但非常謙虛的馬來傳統產後護理治療師對談，交換意見並從中學習相關知識。

馬來或印尼的按摩師以糾正子宮的位置去調理女性的健康是很常見的事。馬來人認為子宮是女性身體的核心，她的外在美反映了子宮的健康情況。在東南亞，我們的祖母和媽媽輩經常提醒我們「戒生凍食物」和「不要提重物」，去保持子宮的健康和福祉。

到底，「子宮下垂」的真正意思是甚麼呢？

當我第一次學習馬來產後按摩時，無論是在大學學府、現代水療中心學院或通過傳統的馬來按摩師的指導，我都會學習到子宮的位置和按摩方法，但是我有好多關於從人體解剖學角度瞭解子宮按摩的科學根據問題還未得到有說服力的解答。

可是，當我到美國猶他州學習Rosita Arvigo博士的Maya腹部治療Arvigo技術®時，說到還原子宮位置和錯位的子宮究竟是如何影響我們的健康時，我終於明白到這兩種馬來與馬雅女性護理文化是如何地相似。Arvigo博士導出特定治療技術，使用外部的、非入侵性的手動操作方法去幫助重新定位生殖器官和改善血液流向消化器官的情況。

接下來我想分享我所學的，以及解釋一下當妳被告知「子宮下垂」時，究竟是甚麼意思。

子宮脫垂是醫學上常見的名稱，指的是子宮滑落到陰道。子宮是一個在非妊娠狀態時有著拳頭大小、中空的肌肉器官。它由14條韌帶和結締組織懸吊在骨盆內，以及由骨盆底肌肉支持著。它位於內側骨盆的下部分，略高於膀胱和在結腸的前面。這允許動脈血可以作最大的循環、從脊柱供應神經、排出靜脈血液和淋巴引流。

子宮是由子宮頸以一條連起來的組織連結至陰道。

當骨盆底肌肉和韌帶被拉長和削弱，不再提供足夠的支持予子宮時，子宮就會脫垂，滑落至或突出陰道。

子宮脫垂的潛在原因包括：

• 支持組織在懷孕和分娩過程損壞
• 地心吸力的影響
• 女性成熟時雌激素減少
• 多年反覆的用力

子宮滑落的原因也可以是因為韌帶和結締組織受到拉伸和縮短，而有時變得扭曲或失去彈性。子宮脫位也可以被簡稱為：

• 子宮傾斜
• 子宮後翻
• 子宮後傾
• 子宮前屈

Maya腹部治療Arvigo技術®教授了正確的知識和子宮重新定位的技術，去幫助醫治子宮脫垂的問題。那麼，為甚麼知道自己子宮的狀況是那麼重要呢？

以下是一些子宮脫位的常見症狀：

• 月經問題──經痛；經早、經遲或月經不調；月經開始或結束時不尋常的深色和血厚；相關的頭痛或偏頭痛
• 泌尿問題──尿頻、膀胱受到感染和尿失禁
• 排卵期的症狀──不規則或排卵痛楚
• 骨關節肌肉的症狀──下腰腰酸，走路時腳後跟痛

是甚麼原因導致這些情況？根據Arvigo博士，主要原因是：

1. 頻密的懷孕和難產

懷孕頻密時，就沒有足夠的時間讓子宮韌帶在下一次受孕前還原它的長度和強度，特別是在體型大的胎兒或難產的情況下。

2. 懷孕、分娩時和產後不必要的壓力被施加在子宮上

子宮上方的的腹部器官可重達40至60磅。女性提重時，膜片就會向下施加壓力予腹部器官上。（在分娩時剛承受過負擔的）骨盆底肌肉可能不能夠承受進一步的壓力和重量，因而時常引致子宮脫垂。提重還可能會損害子宮韌帶和肌壁，並需要時間來癒合。瑪雅人的「faja」（腹部包紮或產後束腹帶）和馬來人的「bengkung」，兩者都由布料製造，可以支持子宮，直至韌帶癒合和回復到其原本的位置，長度。

上圖顯示了被拉伸了的圓韌帶、闊韌帶和子宮骶骨韌帶，連接子宮至骨盆和骶骨。（來源：The Growing Uterus Chart: 40 weeks pregnant at term picture.）

此外：Arvigo博士還列出以下子宮脫位的潛在原因：

• 因子宮內膜異位和子宮肌瘤而引致的黏連疤痕
• 骶骨或尾骨因跌倒或事故而受傷
• 穿著高跟鞋
• 在水泥表面跑動；高強度的舞蹈、健美操或運動
• 久咳不愈
• 老化過程

同樣，馬來人相信在產後是需要讓子宮回復原位的，以防止子宮脫垂和其他併發症，例如失禁。產後的60天是最好的時間，去讓子宮復原至懷孕前的大小和位置，特別是因為考慮到鬆弛激素在這段時間仍然殘留於體內而可以被引導幫助媽媽修身。

Restoring Mums創辦人和治療師Karen Loke