What is uterine prolapse?
A uterine prolapse is a condition where the internal supports of the uterus become weak over time. The uterus is one of the organs that makes up part of your reproductive system. Also called the womb, the uterus is located in your pelvis and is roughly shaped like a pear. During pregnancy, the uterus holds the developing baby. It actually stretches through the pregnancy to fit the baby and then shrinks back down in size after delivery.
Prolapses can vary depending on how weak the supports of the uterus have gotten. In an incomplete prolapse, the uterus may have slipped enough to be partway in the vagina (birth canal). This creates a lump or bulge. In a more severe case, the uterus can slip far enough that it is felt outside of the vagina. This is called a complete prolapse.
Who gets uterine prolapse?
Uterine prolapse is most likely to happen in women who:
- Have had one or more vaginal deliveries.
- Are post-menopausal.
- Have family members who have had prolapse.
Menopause occurs when your ovaries stop producing the hormones that regulate your monthly menstrual cycle (period). When you haven’t had a period for 12 straight months, you are considered menopausal. One of the hormones that stops during menopause is estrogen. This particular hormone helps keep your pelvic muscles strong. Without it, you are 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 are also at a higher risk of uterine prolapses if you have had multiple vaginal deliveries during childbirth throughout your life.
Symptoms and Causes
What causes uterine prolapse?
Your uterus is held in place within the pelvis by a group of muscles and ligaments. You may hear this called the pelvic floor muscles. When these structures weaken, they become unable to hold the 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 aging.
- Injury during childbirth, especially if you have had many babies or large babies (more than 9 pounds).
- Chronic coughing or straining.
- Chronic constipation.
What are the symptoms of uterine prolapse?
If you have a mild case of uterine prolapse, you may not have any obvious symptoms. However, as the uterus slips further out of position, it can place pressure on other pelvic organs—such as the bladder or bowel—and cause symptoms like:
- A feeling of heaviness or pressure in the pelvis.
- Pain in the pelvis, abdomen or lower back.
- Pain during sex (intercourse).
- Uterine tissue that falls through the opening of the vagina.
- Frequent bladder infections.
- Unusual or excessive discharge from the vagina.
- Urination problems, including involuntary loss of urine (incontinence), the need to urinate frequently (urinary frequency) or the sudden urge to urinate (urinary urgency).
Symptoms can get worse when you stand or walk for long periods of time. In these positions, gravity places extra pressure on the pelvic muscles.
Diagnosis and Tests
How is uterine prolapse diagnosed?
The healthcare provider will perform a pelvic examination to determine if the uterus has lowered from its normal position. During a pelvic exam, the healthcare provider inserts a speculum (an instrument that lets the provider see inside the vagina) and examines the vagina and uterus. Your provider will feel for any bulges caused by the uterus dropping down into the vaginal canal.
Management and Treatment
How is uterine prolapse treated?
There are surgical and non-surgical 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 women. Treatment options can include:
- Exercise: Special exercises, called Kegel exercises, can help strengthen the 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 are 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 the uterus (cervix). This device helps prop up the uterus and hold it in place. A healthcare provider will fit and insert the pessary, which must be cleaned frequently and removed before sex.
- Hysterectomy and prolapse repair: Uterine prolapse may be treated by removing the uterus in a surgical procedure called a hysterectomy. This may be done through a cut (incision) made in the vagina (vaginal hysterectomy) or through the abdomen (abdominal hysterectomy). Hysterectomy is major surgery, and removing the uterus means pregnancy is no longer possible.
- Prolapse repair without hysterectomy: This procedure involves putting the uterus back into its normal position. Uterine suspension may be done by reattaching the pelvic ligaments to the lower part of the uterus to hold it in place. The surgery can be done through the vagina or through the abdomen depending on the technique that is used.
What are the complications of uterine prolapse?
If you don’t treat a uterine prolapse, it can impact other organs in the pelvic area of your body. A prolapsed uterus can interfere with your bowel and bladder. It can also negatively impact your sex life, causing you pain.
Can uterine prolapse be prevented?
You may not be able to prevent all cases of uterine prolapse, but there are ways to cut back on your risk of developing a prolapse. A few lifestyle tips that can reduce your risk of prolapse include:
- Maintaining a healthy body weight.
- Exercising regularly. In addition, do Kegel exercises to strengthen your pelvic floor muscles. Remember, check with your healthcare provider before starting any new exercise program.
- Eating a healthy diet. Talk to your healthcare provider or a nutritionist (a special type of healthcare provider who helps you form a meal plan) about the best diet for you.
- Stop smoking. This reduces the risk of developing a chronic cough, which can put extra strain on the pelvic muscles.
- Using proper lifting techniques.
What are proper lifting techniques?
There are several tips for lifting heavy objects that can help you avoid injury. These techniques for lifting include:
- Do not 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 is lower than the level of your waist, keep your back straight, and bend at your knees and hips. Do not bend forward at the waist with your knees straight.
- Stand with a wide stance close to the object you are 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. Do not jerk the object up to your body.
- Stand completely upright without twisting. Always move your feet forward when lifting an object.
- If you are lifting an object from a table, slide it to the edge to the table so that you can hold it close to your body. Bend your knees so that you are 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 stomach muscles and bend your hips and knees.
Outlook / Prognosis
Will a uterine prolapse happen again?
Most of the time, treatment for a uterine prolapse is effective. However, sometimes a prolapse can come back. This is more common if you have a very severe prolapse, are obese or a younger woman (under age 60).
What’s the outlook for uterine prolapse?
In most cases, the outlook for uterine prolapse is very good. There are typically very positive results from treatment for the condition and lifestyle changes (maintaining a good 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 you develop a treatment plan and build good lifestyle habits to prevent any future prolapses.