|Terminology: Also known as prolapsed uterus, fallen uterus or uterine descensus.
What Is Uterine Prolapse?
It is where the uterus (womb) drops down into the vagina. Uterine prolapse is caused by weakening of the muscles (pelvic floor muscles) and ligaments that usually support the uterus and keep it in place. Occasionally other internal organs like the bladder, urethra, rectum or part of the intestines can bulge into the vagina for the same reason. The condition usually results from childbirth, particularly if the baby was large, the labor was long or the mother has had several previous children. It also tends to appear after menopause when reduced estrogen levels, the effects of gravity and straining over the years weaken the muscles. Mild prolapse does not usually require treatment.
Degrees Of Uterine Prolapse
The severity of a prolapse is categorized by the following degrees:
First degree (mild): The cervix (opening that connects the uterus and vagina) droops into the vagina.
Second degree (moderate): The cervix sticks to the opening of the vagina.
Third degree (severe): The cervix sticks outside the vagina.
Fourth degree (very severe): The entire uterus sticks outside the vagina. This condition is called procidentia.
Woman with procidentia. Surgery was required.
Other conditions associated with a prolapsed uterus:
Cystocele: Part of the bladder bulges (herniation) into the vagina.
Enterocele: Part of the intestines bulge into the vagina.
Rectocele: Part of the rectum bulges into the lower rear vaginal wall. This makes bowel movements difficult and you may need to push on the inside of the vagina to have a bowel movement.
What Are The Symptoms?
Symptoms often depend on the severity (degree) of the prolapse, but it is possible (although not usual) for a woman to have severe prolapse without symptoms. You may experience:
• A heaviness or bearing down feeling in the pelvic region.
• Tissue sticking out from the vagina.
• Lower back pain.
• Urine leakages when you sneeze, cough or laugh (stress incontinence).
• A feeling like you are sitting on a small ball when you sit down.
Symptoms worsen as the day progresses. Because of gravity, standing makes it worse and discomfort may be relieved by lying down. If you have a severe prolapse, simply walking can be difficult because the womb and cervix bulge through the vagina, possibly dragging the bladder and rectum with them.
What Causes It?
1. Pregnancy and childbirth trauma (particularly with difficult labors or large babies) causes the muscles to stretch and weaken.
2. Loss of muscle tone to do with aging is another cause. Reduced levels of estrogen after menopause can weaken muscles further.
3. Disorders that cause lots of coughing such as asthma, chronic bronchitis and emphysema can put pressure on the abdomen and increase the risk of a prolapse.
4. It tends to run in families, if your mother, sister, grandmother or aunt had it, you are more likely to.
How Is It Diagnosed?
Your doctor will perform a pelvic examination. During this exam he will ask you to strain like you are having a bowel movement. This allows him to see how far the uterus has dropped into the vagina. You may be asked to strain both when lying down and standing up. An ultrasound scan or MRI scan is not generally used to test for a prolapsed uterus.
How Is It Treated?
If your symptoms are mild or don't bother you, you probably will not require treatment. Your doctor may recommend performing Kegel exercises to strengthen the pelvic floor muscles.
See our articles:
What are pelvic floor exercises?
How do you do pelvic floor exercises?
How many pelvic floor exercises should you do a day?
Obese women often find losing weight also helps to relieve symptoms. Additionally, avoiding heavy lifting puts less pressure on the pelvic structures.
More Severe Cases
If you plan on having more children, your doctor will recommend the use of a small rubber device called a pessary (surgery is considered too risky as it may damage the womb). This device fits inside the vagina and holds the womb in place. Rather like a contraceptive diaphragm, your doctor will need to measure and fit you for the device. He will also tell you how to insert, remove and clean it on a daily basis. Some pessaries are removed at night and reinserted in the morning; which means it does not interfere with sexual intercourse. If for any reason you are uncomfortable with removing and cleaning your pessary, you should see your physician every 2 to 3 months so he can do it for you. Women who are postmenopausal and fitted with a pessary may also be prescribed estrogen replacement therapy to help restore vaginal tissues.
For women who no longer want children, or who are past childbearing age, surgery is another option. It is the only permanent cure. Surgery is also an option for women with severe prolapse, for those who dislike using pessaries and those who find pessaries become less effective over the years. Surgery involves repairing any damaged tissues and muscles and is usually done through the vagina, although occasionally it is performed through the tummy or via minimally invasive laparoscopic surgery (or da Vinci surgery). Each type of surgery has its pros and cons and you will need to discuss your options with a consultant. Surgery is performed with regional (spinal) anesthetic or general anesthetic. If the woman is postmenopausal a hysterectomy (removal of the womb) is another option. Like any major surgery repairing a prolapsed womb has risks (reaction to anesthesia, scarring, infection, bleeding), but the risks are relatively low for women in good health. Putting off surgery until you are older only increases the risks.
Can A Prolapsed Womb Be Prevented?
If you think you may be prone to uterine prolapse, you may be able to prevent the problem by regularly performing kegel exercises. This is particularly true for pregnant women and those with a history of the condition in the family. If you obese, try to lose weight and maintain a healthy body mass index (BMI) for your height - use our BMI calculator to check your health risk.