Uterine Prolapse

Uterine prolapse is when your uterus sags or drops down into your vagina. It occurs when the muscles and tissues around your uterus become weak. Uterine prolapse is a type of pelvic organ prolapse (POP). You can have more than one type of POP at the same time.

This condition can be mild or severe depending on how weak the supporting muscles are. In an incomplete prolapse, your uterus may 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.

A prolapsed uterus isn’t life-threatening. But it can greatly affect your quality of life. The good news is that it’s treatable. You don’t have to live with discomfort.

Symptoms of a prolapsed uterus

If you have a mild case of uterine prolapse, you may not notice symptoms. As your uterus slips farther out of position, it can put pressure on other pelvic organs, like your bladder or bowel. You may have symptoms like:

• A feeling of heaviness, fullness or pressure in your pelvis
• Pain in your pelvis, belly or lower back
• Pain during sex
• Uterine tissue that sags through the opening of your vagina.
• Trouble inserting tampons or other applicators into your vagina
• Constipation
• Peeing problems, including leaking pee, peeing frequently or the sudden urge to pee

Symptoms can worsen when you stand or walk for long periods. In these positions, gravity puts extra pressure on your pelvic muscles. Coughing and sneezing can make symptoms worse, too.

Uterine prolapse causes

Uterine prolapse happens when the muscles, ligaments and tissues that support your uterus in your pelvis weaken. These are your pelvic floor muscles. If they’re damaged or weakened to the point where they can’t provide support, your uterus can drop into or out of your vagina.

Several factors can weaken your pelvic muscles, including:

• Loss of muscle tone as a 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
• Prior pelvic surgeries

Complications

The main physical complications of a prolapsed uterus include difficulty peeing and pooping.

In complete uterine prolapse, your exposed cervix or vaginal wall may get damaged. Severe cases can cause urinary retention or ureteral kinking that can affect your kidneys.

The condition can also take a toll on your mental health and sex life. This is why it’s important to get medical care.

How doctors diagnose this condition

Your healthcare provider will ask about your symptoms. They’ll also do a pelvic exam to check the location of your uterus.

During the exam, your provider will insert a speculum and check your vagina and uterus. Your provider will feel for any bulges. They may ask you to cough, strain or act like you’re holding in your pee. This can help them assess the strength of your pelvic floor muscles.

Your provider may then assign a stage to the prolapse:

• Stage 1: Your uterus drops into the upper part of your vagina.
• Stage 2: Your uterus falls into the lower part of your vagina.
• Stage 3: Your uterus sticks out from your vaginal opening.
• Stage 4: Your entire uterus slips outside of your vaginal opening.

How is it treated?

You may not need treatment for mild uterine prolapse that doesn’t bother you. But if the condition causes discomfort or disrupts your life, treatment can help.

Treatment for a prolapsed uterus may involve nonsurgical therapies or surgery. Together, you and your healthcare provider will discuss your options. Certain factors affect which option is right for you, like:

• The severity of the prolapse
• Your age and general health
• Whether you have other forms of prolapse
• Whether you want to carry a pregnancy in the future
• Whether you want to have vaginal sex

Nonsurgical options

The two main nonsurgical therapies for uterine prolapse include:

• Pelvic floor physical therapy: Physical therapy exercises focus on strengthening your pelvic floor muscles. This may be the only treatment you need for a mild case of uterine prolapse.
• Vaginal pessary: A pessary is a silicone device that fits around or under the lower part of your uterus. It helps prop up your uterus and hold it in place. This is a common treatment choice.

Lifestyle changes can help manage certain symptoms. For example, if you have constipation, adding more fiber to your eating plan may help.

Surgical options

Surgical options for a prolapsed uterus include:

• Sacrocolpopexy: Your surgeon uses a piece of mesh to lift your vagina. It’s often the most durable repair. Your provider may recommend a hysterectomy at the same time if you don’t want a future pregnancy.
• Ligament suspension: Your surgeon attaches your cervix or vaginal cuff to certain ligaments in your pelvis. Surgeons usually do these procedures through your vagina.
• Colpocleisis: Your surgeon sews the walls of your vagina together to hold your pelvic organs in place. You can no longer have vaginal sex after this surgery. It has excellent long-term success.
• Hysteropexy: Your surgeon uses a mesh to attach your uterus and cervix to a ligament. It’s a uterus-sparing surgery.

What can I expect if I have this condition?

Your outlook depends on several factors, like the prolapse severity and the treatment option you choose.

In general, uterine prolapse treatments aren’t quick fixes. You’ll need ongoing care to ensure long-term success. This is especially true if you get surgery. Effective care after surgery and muscle strengthening exercises are key to maintaining a healthy pelvic floor.

Be sure to attend your follow-up appointments with your healthcare provider. Let them know if you have any questions or concerns.

Can this be prevented?

You can’t always prevent uterine prolapse. But some lifestyle tips that can reduce your risk of it include:

• Maintaining a healthy weight and exercising regularly
• Doing Kegel exercises to strengthen your pelvic floor muscles
• Managing coughing, like getting treatment for medical conditions or quitting smoking
• Using proper lifting techniques when carrying heavy objects
• Managing constipation