Description

Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken until they no longer provide enough support for the uterus. As a result, the uterus slips down or sticking out of the vagina.

Uterine prolapse is most often affects people after menopause who have had one or more vaginal births.

Mild uterine prolapse usually doesn't require treatment. But prolapse of the uterus, which causes discomfort or disrupts daily life may benefit from treatment.

Symptoms

Mild uterine prolapse is common after childbirth. Usually does not cause symptoms. The symptoms of moderate to severe uterine prolapse include:

  • Seeing or feeling tissue of the protrusion of the vagina
  • Sensation of heaviness or pulling in the pelvis
  • Feeling that the bladder does not empty all the way when using the bathroom
  • Problems with the output of the urine, also called incontinence
  • Trouble having a bowel movement and the need for the press of the vagina with your fingers to help you to have a bowel movement
  • It feels as if you are sitting in a small ball
  • Feeling as if you have the vaginal tissue rubbing of the clothes
  • Pressure or discomfort in the pelvis or lower back
  • Sexual problems, such as feeling as if the vaginal tissue is loose

When to see a doctor

See a health care provider to discuss treatment options if your symptoms of uterine prolapse bother you and prevent you from doing daily activities.

Causes

Uterine prolapse results from the weakening of the pelvic muscles and supportive tissues. Causes of weakening of the pelvic muscles and tissues are:

  • Vaginal Delivery
  • The age at first birth (older women are at increased risk of pelvic floor injury in comparison with younger women)
  • Difficult labor and delivery, or trauma during childbirth
  • The delivery of a large baby
  • Overweight
  • The lower the level of estrogen after menopause
  • Chronic constipation or straining with bowel movements
  • Chronic cough or bronchitis
  • Repeated lifting of heavy objects

Risk factors

Factors that may increase the risk of uterine prolapse include:

  • Having one or more vaginal deliveries
  • Being older when they have their first baby
  • Giving birth to a large baby
  • Aging
  • Obesity
  • Before the surgery of the pelvis
  • Chronic constipation or often strain during bowel movements.
  • The history of the family of the weakness of the connective tissue
  • Being Hispanic or white
  • Chronic cough, such as smoking

Complications

Uterine prolapse often occurs with the prolapse of other pelvic organs. These types of prolapse can also occur:

  • Anterior prolapse. Anterior prolapse of the results in weak connective tissue between the bladder and the roof of the vagina. This can cause the bladder to bulge into the vagina. This is called a cystocele or prolapsed bladder.
  • Posterior vaginal prolapse. Weak connective tissue between the rectum and the lower part of the vagina can cause the rectum to bulge into the vagina. This can cause difficulty with bowel movements. Posterior vaginal prolapse is also called a rectocele.

Prevention

To reduce the risk of uterine prolapse, try the following:

  • Prevent constipation. Drink plenty of fluids and eat high-fiber foods, such as fruits, vegetables, beans, and whole grains.
  • Avoid lifting heavy objects. If you have to lift something heavy, do it correctly. Correct lifting of the uses of your legs instead of the waist or the back.
  • Control the cough. Receive treatment for a chronic cough or bronchitis. Do not smoke.
  • Avoid weight gain. Talk with your doctor about your ideal weight and get tips on how to lose weight if you need to.

Diagnosis

A diagnosis of uterine prolapse often occurs during a pelvic exam. During the pelvic exam, your health care provider may:

  • Bear down as if having a bowel movement. This can help your provider to assess how far the uterus has been introduced into the vagina.
  • Tighten your pelvic muscles as if you're stopping a stream of urine. This test checks the strength of the muscles of the pelvis.

You can also fill out a questionnaire. This helps your provider to assess how uterine prolapse affects your life. This information helps guide treatment decisions.

If you have severe urinary incontinence, you may have tests to measure how well the bladder works. This is called a urodynamic test.

Treatment

If you have uterine prolapse, and it doesn't bother you, treatment may not be necessary. You can choose to wait and see what happens. But when the symptoms of the prolapse bother you, your doctor may suggest that you:

  • Measures of self-care. Self-care measures may provide relief of symptoms or help prevent the prolapse from getting worse. Self-care measures include exercises to strengthen the pelvic muscles. These are called Kegel exercises. You could also benefit from losing weight and treating constipation.
  • A pessary. A vaginal pessary is a silicone device that is inserted into the vagina. Helps to support the bulging of the tissues. A pessary should be removed periodically for cleaning.

Surgery

Surgery may be needed to repair uterine prolapse. Minimally invasive surgery, called surgery laparoscopic or vaginal surgery may be an option.

If you only have a uterine prolapse, surgery may involve:

  • Take out the uterus. This is called a hysterectomy. Hysterectomy may be recommended for uterine prolapse.
  • A procedure that keeps the uterus in place. This is called a uterus-sparing procedure. These surgeries are for the people who want to have another pregnancy. There is less information about the effectiveness of these types of surgeries. More studies are needed.

But if you have prolapse of other pelvic organs, along with the uterine prolapse, surgery may be a bit more complicated. In conjunction with a hysterectomy to remove the uterus, the surgeon may also:

  • The use of sutures to fix the weaknesses of the structures of the pelvic floor. This can be done in a way that maintains the depth and width of the vagina intact sexual function.
  • Close the opening of the vagina. This procedure is called a colpocleisis. It may allow easier recovery of the surgery. This surgery is only an option for those who no longer want to use the vaginal canal to the sexual activity.
  • Place a piece of mesh to support the vaginal tissues. In this procedure, the vaginal tissues are suspended from the tail bone, the use of a synthetic mesh material.

All surgeries have risks. Risks of surgery for uterine prolapse include:

  • Heavy bleeding
  • Blood clots in the legs or lungs
  • Infection
  • A bad reaction to the anesthesia
  • Lesions in other organs such as the bladder, ureter, or bowel
  • Prolapse occurs again
  • Urinary incontinence

Talk with your doctor about all treatment options to ensure that you understand the risks and benefits of each.

Lifestyle and home remedies

Depending on the severity of uterine prolapse is, self-care measures may provide relief of symptoms. You can try:

  • Strengthen the muscles that support pelvic structures
  • Eat foods rich in fiber and drink plenty of fluids to avoid constipation
  • Avoid straining during bowel movements
  • Avoid lifting heavy objects
  • The Control of the cough
  • Lose weight if you are overweight
  • Stop smoking

Kegel exercises

Kegel exercises strengthen the pelvic floor muscles. A strong pelvic floor provides a better support for the pelvic organs. This can alleviate the symptoms that may occur with uterine prolapse.

To do these exercises:

  • Tighten the pelvic floor muscles as if trying to avoid passing gas.
  • Hold the contraction for five seconds, and then relax for five seconds. If this is too difficult, start with the celebration of two seconds and relax for three seconds.
  • Work up to holding the contractions for 10 seconds at a time.
  • Aim for at least three sets of 10 repetitions each day.

Kegel exercises can be most successful when a physical therapist teaches and reinforces the exercises with biofeedback. Biofeedback uses monitoring devices that help ensure the proper stiffness of the muscles during the time sufficient to work well.

Once you learn how to do them properly, you can do Kegel exercises discreetly just about any time, whether sitting at a desk or relaxing on the couch.

Preparing for your appointment

For prolapse of the uterus, you can see a doctor who specializes in conditions affecting the female reproductive system. This type of doctor is called a gynecologist. Or you can see a doctor who specializes in problems and pelvic floor reconstructive surgery. This type of doctor is called a urogynecologist.

Here's some information to help you prepare for your appointment.

What you can do

Make a list of:

  • Your symptoms and when they began
  • All of the drugs, vitamins, and supplements you are taking, including dose
  • The key to personal and medical information, including other conditions, recent life changes, and the factors of
  • Questions to ask your health care provider

For prolapse of the uterus, some basic questions to ask include:

  • What can I do at home to relieve the symptoms?
  • What are the chances that the prolapse will get worse if I do nothing?
  • What treatment approach do you recommend?
  • How likely is it that the uterine prolapse is going to happen again if I can have a surgery to treat it?
  • What are the risks of the surgery?

Don't hesitate to ask other questions you have.

What to expect from your doctor

Your provider is likely to ask questions such as:

  • The symptoms got worse?
  • Do you have pain in the pelvis?
  • Do you ever leak urine?
  • Has had a severe or continuous cough?
  • Do the heavy lifting in your work or daily activities?
  • Do you strain during bowel movements?
  • Have someone in your family has had prolapse of the uterus or other pelvic problems?
  • How many children have you given birth? Were their vaginal births?
  • Do you plan to have children in the future?
Symptoms and treatment of Uterine prolapse