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Uterine prolapse
Pelvic relaxation - uterine prolapse; Pelvic floor hernia; Prolapsed uterus
Uterine prolapse occurs when the womb (uterus) drops down and presses into the vaginal area.
Causes
Muscles, ligaments, and other structures hold the uterus in the pelvis. If these tissues are weak or stretched, the uterus drops into the vaginal canal. This is called prolapse.
This condition is more common in women who have had 1 or more vaginal births.
Other things that can cause or lead to uterine prolapse include:
- Normal aging
- Lack of estrogen after menopause
- Conditions that put pressure on the pelvic muscles, such as chronic cough and obesity
- Pelvic tumor (rare)
Repeated straining to have a bowel movement due to long-term constipation can make the problem worse.
Symptoms
Symptoms may include:
- Pressure or heaviness in the pelvis or vagina
- Problems with sexual intercourse
- Leaking urine or sudden urge to empty the bladder
- Low backache
- Uterus and cervix that bulge into the vaginal opening
- Repeated bladder infections
- Vaginal bleeding
- Increased vaginal discharge
Symptoms may be worse when you stand or sit for a long time. Exercise or lifting may also make symptoms worse.
Exams and Tests
Your health care provider will do a pelvic exam. You will be asked to bear down as if you are trying to push out a baby. This shows how far your uterus has dropped.
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Uterine prolapse is mild when the
cervix
drops into the lower part of the
vagina
.
Cervix
The cervix is the lower end of the womb (uterus). It is at the top of the vagina. It is about 2 inches (5 centimeters) long. The cervical canal pa...
ImageRead Article Now Book Mark ArticleVagina
The vagina is the female body part that connects the womb (uterus) and cervix to the outside of the body.
ImageRead Article Now Book Mark Article - Uterine prolapse is moderate when the cervix drops out of the vaginal opening.
Other things the pelvic exam may show are:
-
The bladder and front wall of the vagina are bulging into the vagina (
cystocele
).
Cystocele
Stress incontinence occurs when your bladder leaks urine during physical activity or exertion. It may happen when you cough, lift something heavy, c...
ImageRead Article Now Book Mark Article - The rectum and back wall of the vagina (rectocele) are bulging into the vagina.
- The urethra and bladder are lower in the pelvis than usual.
Treatment
You do not need treatment unless you are bothered by the symptoms.
Many women will get treatment by the time the uterus drops to the opening of the vagina.
LIFESTYLE CHANGES
The following can help you control your symptoms:
- Lose weight if you are obese.
- Avoid heavy lifting or straining.
- Get treated for a chronic cough. If you cough is due to smoking, try to quit.
VAGINAL PESSARY
Your provider may recommend placing a rubber or plastic donut-shaped device, into the vagina.This is called a pessary. This device holds the uterus in place.
The pessary may be used for short-term or long-term. The device is fitted for your vagina. Some pessaries are similar to a diaphragm used for birth control.
Pessaries must be cleaned regularly. Sometimes they need to be cleaned by the provider. Many women can be taught how to insert, clean, and remove a pessary.
Side effects of pessaries include:
- Foul smelling discharge from the vagina
- Irritation of the lining of the vagina
- Ulcers in the vagina
- Problems with normal sexual intercourse
SURGERY
Surgery should not be done until the prolapse symptoms are worse than the risks of having surgery. The type of surgery will depend on:
- The severity of the prolapse
- The woman's plans for future pregnancies
- The woman's age, health, and other medical problems
- The woman's desire to retain vaginal function
There are some surgical procedures that can be done without removing the uterus, such as a sacrospinous fixation. This procedure involves using nearby ligaments to support the uterus. Other procedures are also available.
Often, a vaginal hysterectomy is used to correct uterine prolapse. Any sagging of the vaginal walls, urethra, bladder, or rectum can be surgically corrected at the same time.
Vaginal hysterectomy
Hysterectomy is surgery to remove a woman's womb (uterus). The uterus is a hollow muscular organ that nourishes the developing baby during pregnancy...
Outlook (Prognosis)
Most women with mild uterine prolapse do not have symptoms that require treatment.
Vaginal pessaries can be effective for many women with uterine prolapse.
Surgery often provides very good results. However, some women may need to have the treatment again in the future.
Possible Complications
Ulceration and infection of the cervix and vaginal walls may occur in severe cases of uterine prolapse.
Urinary tract infections and other urinary symptoms may occur because of a cystocele. Constipation and hemorrhoids may occur because of a rectocele.
Urinary tract infections
A urinary tract infection, or UTI, is an infection of the urinary tract. The infection can occur at different points in the urinary tract, including...
Constipation
Constipation in infants and children occurs when they have hard stools or have problems passing stools. A child may have pain while passing stools o...
Hemorrhoids
Hemorrhoids are swollen veins in the anus or lower part of the rectum.
When to Contact a Medical Professional
Call your provider if you have symptoms of uterine prolapse.
Prevention
Tightening the pelvic floor muscles using Kegel exercises helps to strengthen the muscles and reduces the risk of uterine prolapse.
Kegel exercises
Pelvic floor muscle training exercises are a series of exercises designed to strengthen the muscles of the pelvic floor.
Estrogen therapy after menopause may help with vaginal muscle tone.
References
Lentz GM. Anatomic defects of the abdominal wall and pelvic floor: abdominal and inguinal hernias, cystocele, urethrocele, enterocele, rectocele, uterine and vaginal prolapse: diagnosis and management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology . 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 20.
Maher CF, Karram M. Surgical procedures to suspend a prolapsed uterus. In: Karram M, Maher CF, eds. Surgical Management of Pelvic Organ Prolapse . Philadelphia, PA: Elsevier Saunders; 2013:chap 5.
Payne CK. Conserative management of urinary incontinence. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 10th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 69.
Winters JC, Togamai JM, Chermansky CJ. Vaginal and abdominal reconstructive surgery for pelvic organ prolapse. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 10th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 72.
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Female reproductive anatomy - illustration
External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries and cervix.
Female reproductive anatomy
illustration
-
Uterus - illustration
The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.
Uterus
illustration
-
Female reproductive anatomy - illustration
External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries and cervix.
Female reproductive anatomy
illustration
-
Uterus - illustration
The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.
Uterus
illustration
Review Date: 9/26/2015
Reviewed By: Daniel N. Sacks MD, FACOG, obstetrics & gynecology in private practice, West Palm Beach, FL. Review Provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
