Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Complications | Prevention

Definition

Uterine prolapse occurs when the uterus slips out of place and into the vaginal canal due to weakening of the muscles and ligaments of the lower abdomen (called the “pelvic floor”), which normally support the uterus and other organs in the pelvis. The severity of uterine prolapse is defined as:

  • First degree (mild)—the cervix (the lower opening of the uterus into the vagina) protrudes into the lower third of the vagina
  • Second degree (moderate)—the cervix protrudes past the vaginal opening
  • Third degree (severe)—the entire uterus protrudes past the vaginal opening

Other organs, such as the ovaries or bladder, may also be out of place due to the weakening of the pelvic floor tissues.

Uterine Prolapse

uterine prolapse
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Causes

The uterus is normally supported by pelvic connective tissue and held in position by special ligaments. Weakening of these tissues causes the uterus to descend into the vaginal canal.

Risk Factors

The following factors are associated with an increased risk of uterine prolapse:

  • Multiple pregnancies and vaginal deliveries —Uterine prolapse occurs most commonly in women who have had one or more vaginal births. Tissue trauma sustained during childbirth, especially with large babies or difficult labor and delivery, is typically the cause of muscle weakness.
  • Retroverted uterus (positioned backwards from normal)
  • Age (especially after menopause)—The loss of muscle tone and the relaxation of muscles, which are both associated with normal aging and a reduction in the female hormone estrogen, are also thought to play role in the development of uterine prolapse.
  • Obesity —This places additional strain on the supportive muscles of the pelvis.
  • Large uterine or ovarian tumors—Prolapse can also be caused by a pelvic tumor.
  • Activities increasing the pressure in the abdomen and pelvis, including:
  • Race: Caucasian

Symptoms

There may be no symptoms for mild cases of uterine prolapse. Symptoms for more severe cases may include:

  • Sensation of fullness in the vagina
  • Sensation of pulling in the pelvis
  • Pain in the vagina, lower back, or lower abdomen
  • Vaginal discharge
  • Leakage of urine
  • Difficulty voiding urine
  • Frequent urinary tract infections
  • Protrusion of pink tissue from the vagina that may be irritated or itchy

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will also be done. This includes a pelvic exam.

Treatment

Treatment may include:

Kegel Exercises

For mild cases of uterine prolapse, Kegel exercises may be recommended to strengthen the pelvic muscles. These exercises are easy to do and can be done anywhere, at any time. To do Kegel exercises:

  • Squeeze the pelvic muscles as though you are trying to hold back urine.
  • Hold this position for a count of ten, then release slowly.
  • Do this ten times, four times daily.

Medication

Hormone Replacement Therapy

Estrogen may help prevent further weakness of the pelvic floor. Estrogen therapy has many risks, though. Talk to your doctor about the risks and benefits of this form of therapy.

Other Medicines

Your doctor may recommend that you take a stool softener or laxatives to treat constipation.

Referral to a Specialist

You may be referred to a gynecologist or a urogynecologist for further evaluation or surgery.

Pessary Insertion

This is a rubbery, doughnut-shaped device. It is inserted by your doctor into the upper part of the vagina. A pessary helps to prop up the uterus and bladder, and temporarily prevents sagging into the vagina. It will need to be removed for cleaning. Depending on the type of pessary, you may be able to have sex with the device in place.

If you have a pessary, follow these guidelines:

  • Periodically remove the device. To remove it, empty your bladder. Insert two fingers into your vagina. Grab the pessary, slowly turn it, and pull down. Find a good position (eg, lying down, squatting over a toilet, or with one leg lifted on a chair or toilet).
  • Clean the device with soap and water as directed. In some cases, you may need to go to the doctor's office to have your device cleaned.
  • To insert it, apply a lubricant (eg, KY Jelly) to the tip of the pessary. Open your vagina with one hand, and insert the pessary with the other. Firmly push up.
  • Report any discomfort to your doctor.

Surgery

Surgery may be needed for severe uterine prolapse. These procedures are usually not done until you have finished having children. Options include:

  • Hysterectomy —This is the removal of the uterus through the vagina. This will permanently resolve uterine prolapse, but it also results in infertility.
  • Vaginal repair—This is usually done with a hysterectomy. The repair can be done with sutures and with insertion of mesh or slings.
  • Colpocleisis—This involves closing the vagina. It is done only in women who are elderly and who are no longer sexually active.

Lifestyle Changes

If you smoke, ask your doctor about strategies to quit . Smoking can cause a chronic cough, which can further weaken your pelvic muscles.

If you have to do a lot of heavy lifting, talk to your doctor about effective lifting techniques. Lifting may also weaken your pelvic muscles.

Complications

Urinary tract infections and other urinary symptoms may occur due to cystocele. This occurs when the wall between the bladder and the vagina weakens, causing the bladder to drop or sag into the vagina.

Hemorrhoids and constipation may also occur as a result of rectocele. This is a similar condition to cystocele. The rectum protrudes into the vagina. If you are constipated, eating more fiber can help.

In more severe cases of prolapse, ulceration and infection may occur.

Prevention

To help prevent uterine prolapse:

  • Do Kegel exercises regularly, especially before and after childbirth.
  • Avoid constipation. Straining from constipation stresses the pelvic muscles.
  • Maintain a healthy weight through diet and exercise.
  • Quit smoking.
  • Limit heavy lifting.
  • If you are menopausal, discuss hormone replacement therapy with your doctor. HRT at menopause helps retain muscle tone, which may prevent uterine prolapse. However, there are health risks associated with this treatment. Discuss all risks and benefits with your doctor.