Uterine Prolapse

Uterine prolapse occurs when the pelvic floor muscles and ligaments stretch and weaken and no longer support the uterus. As a result, the uterus slips into the vagina or protrudes through it.

Uterine prolapse often affects postmenopausal women who have one or more normal vaginal deliveries, but it can occur in women at any age.

Mild uterine prolapse does not require treatment, but if it makes you uncomfortable or disrupts your normal life, you may benefit from treatment.

Symptoms

In general, mild uterine prolapse does not cause signs or symptoms. Signs and symptoms of moderate or severe uterine prolapse include:

  • Feeling of heaviness or pulling in the pelvis
  • Tissue protruding from the vagina
  • Urinary problems, such as urine leakage or urinary retention
  • Difficulty defecating
  • Feeling that you are sitting on a small ball or as if something is falling out of your vagina
  • Sexual problems, such as a feeling of looseness in the vaginal tissue
Causes

Uterine prolapse occurs when the pelvic muscles and supporting tissues are weakened. Causes of weakened pelvic and tissue muscles include:

  • Pregnancy
  • Difficult labor and delivery or trauma during childbirth
  • Delivery of a large child
  • Being overweight or obese
  • Decreased estrogen levels after menopause
  • Chronic constipation
  • Rectal fullness or pressure
  • Bronchitis and acute cough
  • Heavy lifting
Complications

Uterine prolapse is often associated with prolapsed pelvic organs.

  • Anterior prolapse (cystocele):

Weak connective tissue separating the bladder and vagina may cause the bladder to bulge into the vagina. An anterior prolapse is also called a prolapsed bladder.

  • Posterior vaginal prolapse (rectal hernia):

Weak connective tissue separating the bladder and vagina may cause the rectum to bulge into the vagina. You may have difficulty having bowel movements.

Acute uterine prolapse can displace a portion of the vaginal lining, causing it to protrude outside the body. Contact of vaginal tissue with clothing can lead to vaginal ulcers (sores).

Diagnosis

Uterine prolapse is usually diagnosed during a pelvic exam.

During your pelvic exam, your doctor may ask you to:

  • To bear down as if you are having a bowel movement. Bearing down can help your doctor assess the extent of uterine slip into the vagina.
  • To tighten your pelvic muscles, as if you are holding some urine. This test checks the strength of the pelvic muscles.

You may be asked to answer some questions that help your doctor assess how the uterus prolapse affects your quality of life. This information helps your doctor make treatment decisions.

If you have severe urinary incontinence, your doctor may recommend tests to measure your bladder function.

Treatment

Treatment depends on the severity of the uterus prolapse. Your doctor may recommend:

  • Self-care measures:

    If your uterine prolapse causes few or no symptoms, simple self-care measures may provide relief or help prevent the condition from worsening. Self-care measures include Kegel exercises to strengthen the pelvic muscles, losing weight, and treating constipation.

  • The vaginal pessary is a plastic or rubber ring inserted into the vagina to support the protruding tissue. A pessary should be removed regularly to be cleaned.
Surgery

Your doctor may recommend surgery to repair uterine prolapse. Minimally invasive (laparoscopic) or vaginal surgery may be an available option.

Surgery may include:

  • Repair weakened pelvic floor tissue:

    This surgery is usually performed vaginally, but sometimes it is performed through the abdomen. The surgeon might graft your own tissue, donor tissue, or synthetic material to patch the weakened pelvic floor structure to support the pelvic organs.

  • Removal of the uterus (hysterectomy):

    Hysterectomy may be recommended to treat uterine prolapse in specific cases. Generally, a hysterectomy is very safe, but any surgery carries the risk of complications.

Talk to your doctor about all treatment options available to make sure you understand their risks and benefits, so you can choose the best one for you.

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