Uterine Prolapse

What is uterine prolapse?

Uterine prolapse is a condition where the muscles and tissues around your uterus become weak. This causes your uterus to sag or drop down into your vagina. It can happen to anyone assigned female at birth (AFAB), but is most common after menopause and in people who’ve had more than one vaginal delivery.

The muscles, ligaments and tissues in your pelvis are called your pelvic floor muscles. These muscles support your uterus, rectum, vagina, bladder and other pelvic organs. A prolapse occurs when your pelvic floor muscles are damaged or weakened to the point where they can no longer provide support. This causes your pelvic organs to drop into or out of your vagina.

Uterine prolapse can be mild or severe depending on how weak the supporting muscles of your uterus have become. In an incomplete prolapse, your uterus may have slipped enough to be partway in your vagina. This creates a lump or bulge. In a more severe case, your uterus can slip far enough that it comes out of your vagina. This is called a complete prolapse.

What are the stages of uterine prolapse?

Your healthcare provider may use a system to classify uterine prolapse. The stages of uterine prolapse are:

• Stage I: Your uterus drops into the upper part of your vagina.
• Stage II: Your uterus falls into the lower part of your vagina.
• Stage III: Your uterus is protruding from your vagina.
• Stage IV: Your entire uterus slips outside of your vagina.

Who gets uterine prolapse?

Uterine prolapse is most likely to happen in people who:

• Have had one or more vaginal deliveries.
• Have reached menopause.
• Have a family history of uterine prolapse.
• Have had prior pelvic surgeries.

Menopause occurs when your ovaries stop producing the hormones that regulate your monthly menstrual period. One of these hormones is estrogen. This particular hormone helps keep your pelvic muscles strong. Without it, you’re at a higher risk of developing a prolapse.

How common is uterine prolapse?

Uterine prolapse is a fairly common condition. Your risk of developing the condition increases with age. You’re also at a higher risk of uterine prolapses if you’ve had multiple vaginal deliveries.

How serious is a prolapsed uterus?

Uterine prolapse can disrupt normal activities and be uncomfortable. Very mild cases may not require treatment or cause any discomfort. However, severe cases may make it difficult to pee or have a normal bowel movement. Uterine prolapse is typically a quality of life issue, and healthcare providers treat it when symptoms of the condition begin to interfere with your daily life.

What does a prolapsed uterus feel like?

If you have a mild case of uterine prolapse, you may not have any obvious symptoms. But as your uterus slips farther out of position, it can put pressure on other pelvic organs — such as your bladder or bowel — and cause symptoms like:

• A feeling of heaviness, fullness or pressure in your pelvis.
• Pain in your pelvis, abdomen or lower back.
• Pain during sex (intercourse).
• Uterine tissue that falls through the opening of your vagina.
• Trouble inserting tampons or other applicators into your vagina.
• Constipation.
• Urination problems, including leaking pee (incontinence), the need to pee frequently (urinary frequency) or the sudden urge to pee (urinary urgency).

Symptoms can get worse when you stand or walk for long periods of time or when you cough and sneeze. In these positions, gravity puts extra pressure on your pelvic muscles.

What causes uterine prolapse?

Your uterus is held in place within your pelvis by a group of muscles and ligaments (pelvic floor muscles). When these structures weaken, they become unable to hold your uterus in position and it begins to sag. Several factors can contribute to the weakening of the pelvic muscles, including:

• Loss of muscle tone as the result of menopause.
• Pregnancy.
• Vaginal childbirth, especially if you’ve had many babies or large babies (more than 9 pounds).
• Obesity.
• Chronic coughing or straining.
• Chronic constipation.
• Repeated heavy lifting.

What conditions are associated with uterine prolapse?

Other organs in your pelvic region can fall out of position when the muscles around it become too weak. Some of the other types of pelvic organ prolapse are:

• Cystocele: When your bladder drops into or out of your vagina.
• Rectocele: When your rectum bulges into or out of your vagina.
• Enterocele: When part of your small intestine bulges into your vagina.

How is uterine prolapse diagnosed?

Your healthcare provider will perform a pelvic examination to determine if your uterus has lowered from its normal position. During a pelvic exam, your healthcare provider inserts a speculum (an instrument that lets them see inside your vagina) and examines your vagina and uterus. Your provider will feel for any bulges caused by your uterus dropping down into your vaginal canal. They may also ask you to cough, strain or act like you’re holding in your pee. This can help them see how weak your muscles are.

How do you fix a prolapsed uterus?

There are surgical and nonsurgical options for treating uterine prolapse. Your healthcare provider will pick your treatment path based on the severity of your prolapse, your general health, age and whether or not you want children in the future. Treatment is generally effective for most people. Treatment options can include:

Nonsurgical options

• Exercise: Special exercises, called Kegel exercises, can help strengthen your pelvic floor muscles. This may be the only treatment needed in mild cases of uterine prolapse. To do Kegel exercises, tighten your pelvic muscles as if you’re trying to hold back urine. Hold the muscles tight for a few seconds and then release. Repeat 10 times. You may do these exercises anywhere and at any time (up to four times a day).
• Vaginal pessary: A pessary is a rubber or plastic doughnut-shaped device that fits around or under the lower part of your uterus (cervix). This device helps prop up your uterus and hold it in place. A healthcare provider will fit and insert the pessary, which must be cleaned frequently and removed before sex.
• Diet and lifestyle: Changes to your diet and lifestyle may be helpful in relieving symptoms like constipation. Increasing your water and fiber intake may lessen how often you strain to poop. Maintaining a healthy weight for your body type puts less pressure on your pelvic muscles when you stand or walk.

Surgical options

• Hysterectomy and prolapse repair: Uterine prolapse may be treated by removing your uterus in a surgical procedure called a hysterectomy. This may be done through a cut (incision) made in your vagina (vaginal hysterectomy) or through your abdomen (abdominal hysterectomy). Hysterectomy is major surgery, and removing your uterus means pregnancy is no longer possible.
• Prolapse repair without hysterectomy: This procedure involves putting your uterus back into its normal position. Uterine suspension may be done by reattaching the pelvic ligaments to the lower part of your uterus to hold it in place. The surgery can be done through your vagina or through your abdomen depending on the technique your provider uses.

What happens if a prolapsed uterus is left untreated?

It depends on the severity of the prolapse. In mild cases where your quality of life isn’t affected, your healthcare provider may not recommend treatment. Uterine prolapse can affect other organs in the pelvic area of your body (like your bladder and rectum). Healthcare providers typically recommend treatment when uterine prolapse becomes bothersome.

Can I push my prolapsed uterus back up?

No, you can’t push your uterus back up. Only your healthcare provider can treat a prolapsed uterus.

How can I reduce my risk of uterine prolapse?

Some factors like having multiple vaginal births or experiencing menopause can’t be avoided.

There are ways to reduce your risk of developing a prolapse. A few lifestyle tips that can reduce your risk of prolapse include:

• Maintain a healthy weight and exercise regularly.
• Do Kegel exercises to strengthen your pelvic floor muscles.
• Stop smoking. This reduces the risk of developing a chronic cough, which can put extra strain on your pelvic muscles.
• Using proper lifting techniques when carrying heavy objects.
• Avoid becoming constipated or straining to poop.

Proper lifting techniques to avoid uterine prolapse

There are several tips for lifting heavy objects that can help you avoid injury, including:

• Don’t try to lift objects that are oddly shaped or too heavy for you to lift alone. Also, avoid lifting heavy objects above waist level.
• Before you lift an object, make sure you have firm footing.
• To pick up an object that’s lower than the level of your waist, keep your back straight, and bend at your knees and hips. Don’t bend forward at your waist with your knees straight.
• Stand with a wide stance close to the object you’re trying to pick up, and keep your feet firm on the ground. Tighten your stomach muscles and lift the object using your leg muscles. Straighten your knees in a steady motion. Don’t jerk the object up to your body.
• Stand completely upright without twisting. Always move your feet forward when lifting an object.
• If you’re lifting an object from a table, slide it to the edge of the table so you can hold it close to your body. Bend your knees so you’re close to the object. Use your legs to lift the object and come to a standing position.
• Hold packages close to your body with your arms bent. Keep your stomach muscles tight. Take small steps and go slowly.
• To lower the object, place your feet as you did to lift, tighten your stomach muscles and bend your hips and knees.

Can uterine prolapse happen again?

Most of the time, treatment for uterine prolapse is effective. But sometimes, a prolapse can come back. This is more common if you:

• Have a very severe prolapse.
• Have obesity.
• Are younger than 60.

What’s the outlook for uterine prolapse?

In most cases, the outlook for uterine prolapse is very good. Seeking treatment and making lifestyle changes (maintaining a healthy weight and exercising) can help prevent a prolapse from happening again. Talk to your healthcare provider about any concerns you may have about prolapses. Your provider can help develop a treatment plan and build good lifestyle habits to prevent any future prolapses.

When should I see my healthcare provider?

Contact your healthcare provider if you have any of the following signs of uterine prolapse:

• You feel like something is stuck in or coming out of your vagina.
• It’s painful to pee or poop.
• You have chronic low back pain or pelvic pressure that’s not caused by another condition.

A note from Cleveland Clinic

Uterine prolapse is a condition common in people who’ve had several vaginal deliveries or have gone through menopause. Symptoms vary depending on how far your uterus has slipped out of place, but it can be quite uncomfortable. Talk to your provider if you have symptoms of a prolapsed uterus like bulging from your vagina or pressure in your pelvic area. There are treatments to help you feel better before other organs are affected.