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Definition
Uterine prolapse means your uterus has descended from its position in the pelvis farther down into your vagina. Normally, your uterus is held in place by the muscles and ligaments that make up your pelvic floor. Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus. The uterus then descends into the vaginal canal.
Uterine prolapse often affects postmenopausal women who've had one or more vaginal deliveries. Damage sustained by supportive tissues during pregnancy and childbirth, plus the effects of gravity, loss of estrogen and repeated straining over the years, can weaken pelvic floor muscles and tissues and lead to uterine prolapse.
If you have mild uterine prolapse, treatment usually isn't needed. But if the condition makes you uncomfortable or disrupts your normal life, you might benefit from treatment. Options include using a supportive device (pessary), which is inserted into your vagina, or having surgery to repair the prolapse.
Symptoms
Uterine prolapse varies in severity. You may have mild uterine prolapse and experience no signs or symptoms. Or you could have moderate to severe uterine prolapse. If that's the case, you may experience the following:
- Sensation of heaviness or pulling in your pelvis
- Tissue protruding from your vagina
- Urinary difficulties, such as urine leakage or urge incontinence
- Trouble having a bowel movement
- Low back pain
- Feeling as if you're sitting on a small ball or as if something is falling out of your vagina
- Symptoms that are less bothersome in the morning and worsen as the day goes on
Causes
Pregnancy and trauma incurred during childbirth, particularly with large babies or after a difficult labor and delivery, are the main causes of muscle weakness and stretching of supporting tissues leading to uterine prolapse. Loss of muscle tone associated with aging and reduced amounts of circulating estrogen after menopause also may contribute to uterine prolapse. In rare circumstances, uterine prolapse may be caused by a tumor in the pelvic cavity.
Genetics also may play a role. Women of Northern European descent have a higher incidence of uterine prolapse than do women of Asian and African descent.
Risk factors
Certain factors may increase your risk of uterine prolapse:
- One or more pregnancies and vaginal births
- Giving birth to a large baby
- Increasing age
- Frequent heavy lifting
- Chronic coughing
- Frequent straining during bowel movements
Some conditions, such as obesity, chronic constipation and chronic obstructive pulmonary disease (COPD), can place a strain on the muscles and connective tissue in your pelvis and may play a role in the development of uterine prolapse.
When to seek medical advice
If you develop any signs and symptoms of uterine prolapse — such as a feeling of fullness in your vagina or pain during intercourse — or if you also are having difficulties with urination or bowel movements, seek medical attention.
Tests and diagnosis
Diagnosing uterine prolapse requires a pelvic examination. You may be referred to a doctor who specializes in conditions affecting the female reproductive tract (gynecologist). The doctor will ask about your medical history, including how many pregnancies and vaginal deliveries you've had. He or she will perform a complete pelvic examination to check for signs of uterine prolapse. You may be examined while lying down and also while standing. Your doctor may instruct you to cough or bear down as if you're having a bowel movement. Sometimes imaging tests, such as ultrasound or magnetic resonance imaging (MRI), might be performed to further evaluate the uterine prolapse.
Complications
Possible complications include:
- Ulcers. In severe cases of uterine prolapse, part of the vaginal lining may be displaced by the fallen uterus and exposed outside your body. Such exposure may lead to vaginal sores (ulcers). In rare cases, the sores could become infected.
- Prolapse of other pelvic organs. If you experience uterine prolapse, you might also have prolapse of other pelvic organs, including your bladder and rectum. A prolapsed bladder bulges into the front part of your vagina, causing a cystocele that can lead to difficulty in urinating and increased risk of urinary tract infections. Weakness of connective tissue overlying the rectum may result in a prolapsed rectum (rectocele), which may lead to difficulty having bowel movements.
Treatments and drugs
Losing weight, stopping smoking and getting proper treatment for contributing medical problems, such as lung disease with coughing, may slow the progression of uterine prolapse.
If you have very mild uterine prolapse, either without symptoms or with symptoms that aren't terribly bothersome, no treatment is necessary. However, your pelvic floor may continue to lose tone, making the uterine prolapse more severe.
Possible treatments for uterine prolapse include:
- Lifestyle changes. If you're overweight or obese, your doctor may suggest ways to achieve a healthy weight and maintain that weight. Exercises to strengthen your pelvic floor muscles (Kegel exercises) may help relieve some symptoms. Your doctor may advise you to avoid heavy lifting or straining.
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Vaginal pessary. A vaginal pessary fits inside the vagina and is designed to hold the uterus in place. The pessary can be a temporary or permanent form of treatment. Vaginal pessaries come in many shapes and sizes, so your doctor will measure and fit you for a device. Once the pessary is in place, your doctor may have you walk, sit, squat and bear down to make sure that the pessary fits you correctly, doesn't become dislodged and feels reasonably comfortable. You may be asked to return a few days after insertion of the pessary to check that it's still in the correct position. You may be advised to remove the device and clean it with soap and water frequently. Your doctor will show you how to remove and reinsert the pessary. You may be able to leave the pessary out overnight and reinsert it each day to use only during waking hours.
There are some drawbacks to these devices. A vaginal pessary may be of little use for a woman with severe uterine prolapse. Additionally, a vaginal pessary can irritate vaginal tissues, possibly to the point of causing small sores. Women with vaginal pessaries that aren't removed frequently for cleaning may report a foul-smelling discharge. Pessaries may interfere with sexual intercourse.
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Surgery to repair uterine prolapse. If lifestyle changes fail to provide relief from symptoms of uterine prolapse, or if you'd prefer not to use a pessary, surgical repair is an option. Surgical repair of uterine prolapse usually requires vaginal hysterectomy to remove your uterus and excess vaginal tissue. However, in some cases, surgical repair may be possible through a graft of your own tissue, donor tissue or some synthetic material onto weakened pelvic floor structures to support your pelvic organs.
Doctors generally prefer to perform uterine prolapse repair vaginally because vaginal procedures are associated with less pain after surgery, faster healing and a better cosmetic result. However, vaginal surgery may not provide as lasting a fix as abdominal surgery. And if you don't have your uterus removed during surgery, prolapse can recur. Laparoscopic techniques — using smaller abdominal incisions, a lighted camera-type device (laparoscope) to guide the surgeon and specialized surgical instruments — offer a minimally invasive approach to abdominal surgery.
You might not be a good candidate for surgery to repair uterine prolapse if you plan to have more children. Pregnancy and delivery of a baby put strain on the supportive tissues of the uterus and can undo the benefits of surgical repair. Also, for women with major medical problems, anesthesia for surgery might pose too great a risk. Pessary use may be your best treatment choice for bothersome symptoms in these instances.
Prevention
Uterine prolapse may not be something you can prevent. However, you may be able to decrease your risk of uterine prolapse if you:
- Maintain a healthy weight. By keeping or getting your weight under control, you may decrease your risk of uterine prolapse.
- Practice Kegel exercises. Because pregnancy and childbirth can weaken pelvic floor muscles and connective tissue, your doctor may recommend Kegel exercises — special exercises in which you repeatedly squeeze and relax the muscles of your pelvic floor — during pregnancy and afterward. To perform these exercises, tighten your pelvic muscles as if you're stopping your stream of urine. Hold for a count of five, relax and repeat. Do these exercises several times a day.
- Control coughing. Treat a chronic cough or bronchitis, and don't smoke.
Last Updated: 04/10/2008
