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Diseases & Conditions

Vaginal and Uterine Prolapse

What is prolapse?

The organs of the pelvis—the area of the body between the hip bones—include the vagina, cervix, uterus, bladder, urethra, intestines, and rectum. These organs are held in place by a group of muscles and other tissue. When this support system becomes stretched or torn, it allows pelvic organs to slip out of their normal places or sag down (prolapse).

What is the vagina?

The vagina is also called the birth canal. It connects the uterus to the outside of a woman’s body.

What is the uterus?

The uterus also is known as the womb, which is the place where a baby develops.

Normal vagina and uterus

Prolapsed uterus

What is vaginal and uterine prolapse?

A prolapse occurs when an organ of the body droops down or slips out of its normal place. Prolapses that involve the vagina and uterus include the following:

  • Uterine prolapse – The uterus bulges or slips into the vagina, sometimes so far that it comes out of the vaginal opening.
  • Vaginal vault prolapse – The top of the vagina (known as the “vaginal vault”) droops down into the vaginal canal. This usually occurs in women who have had a hysterectomy (removal of the uterus).
  • Cystocele – The bladder drops into the vagina.
  • Rectocele

    Enterocele

  • Urethrocele – The urethra (the tube that carries urine away from the bladder) bulges into the vagina. A cystocele and urethrocele are often found together.
  • Rectocele – The rectum bulges into or out of the vagina.
  • Enterocele – The small intestine bulges against the back wall of the vagina. An enterocele and vaginal vault prolapse often occur together.

Prolapsed vagina

Cystocele

What causes vaginal and uterine prolapse?

The organs of the pelvis—the area of the body between the hip bones—include the vagina, cervix, uterus, bladder, urethra, intestines and rectum. These organs are held in place by a group of muscles and other tissue. When this support system becomes stretched or torn, it allows pelvic organs to sag down, or prolapse. The most common causes of vaginal and uterine prolapse are as follows:

  • Childbirth – Vaginal delivery raises the risk of prolapse more than a cesarean section (when the baby is delivered through a surgical opening in the wall of the abdomen). It is also thought that the more children a woman delivers, as well as the delivery of a large baby (more than nine pounds), will raise the risk of prolapse.
  • Surgery, such as a hysterectomy, or radiation treatment in the pelvic area.
  • Menopause – A woman’s ovaries stop producing hormones that regulate her monthly cycle. The hormone estrogen, which helps keep pelvic muscles strong, is in lower supply.
  • Aging.
  • Extreme physical activity or lifting of heavy objects.
  • Any condition that puts pressure on the abdominal area, such as being overweight, straining to have a bowel movement, or an intense or long-lasting cough such as in smokers or people with asthma.
  • Genetic or hereditary factors – One person’s pelvic support system may be naturally weaker than another’s.

What are the symptoms of vaginal and uterine prolapse?

In many cases a woman will feel no symptoms from prolapse and will find out about it only during an exam.

In cases where symptoms do occur, the following are most common:

  • A feeling of fullness, heaviness or pain in the pelvic area. Often this feeling gets worse as the day goes on or gets worse after standing, lifting or coughing.
  • Lower back pain.
  • Bulging in the vagina.
  • Organs slipping out of the vagina.
  • Leakage of urine.
  • Bladder infections.
  • Difficulty having a bowel movement or needing to push organs back into place following a bowel movement.
  • Problems with sexual intercourse.
  • Problems inserting tampons.

How common is vaginal and uterine prolapse?

More than one-third of women in the U.S. have some sort of pelvic area prolapse. Almost 25% feel some symptoms from the condition. Up to 11% of women require surgery for prolapse at some point in their lifetime.

How is vaginal and uterine prolapse diagnosed?

Often a physical exam is all that is needed to diagnose prolapse. If additional information is needed, a number of tests may be done that measure how well each of the pelvic organs is working.

How is vaginal and uterine prolapse treated?

  • Hysterectomy – Surgical removal of the uterus in cases of severe uterine prolapse.
  • Uterine suspension – Putting the uterus back in its normal position, either by connecting support tissue to the lower part of the uterus, or by using a mesh material that forms a sling to hold it in place.
  • Kegel exercises – Tightening and relaxing the muscles used to control the flow of urine in order to strengthen the muscles that support the pelvic organs.
  • Taking the hormone estrogen – Helps prevent further weakening of pelvic support muscles but has a number of possible negative side effects.
  • Vaginal pessary – A removable rubber or plastic device inserted into the vagina to provide support in the area of the prolapse. Pessaries are most often used when the patient wants to avoid surgery or has medical problems that make surgery too risky.
References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 11/8/2015…#16030