Uterine Prolapse

Uterine prolapse most often occurs in women who have had more than one baby through normal vaginal delivery and in post-menopausal women. Menopause occurs when a woman's ovaries stop producing the hormones that regulate her monthly menstrual cycle, and she stops having regular menstrual periods. One of these hormones, estrogen, helps keep the pelvic muscles strong.

What is uterine prolapse?

Uterine prolapse is falling or sliding of the uterus from its normal position in the pelvic cavity into the vaginal canal.

Symptoms of uterine prolapse

A) A feeling as if "sitting" on a small ball

B) Difficult or painful sexual intercourse

C) Low backache

D) Protrusion from the vaginal opening

E) Sensation of heaviness or pulling in the pelvis

F) Vaginal bleeding

Risk factors

By Mayo Clinic staff

Certain factors may increase your risk of uterine prolapse:

1) One or more pregnancies and vaginal births

2) Giving birth to a large baby

3) Increasing age

4) Frequent heavy lifting

5) Chronic coughing

6) 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.

Causes of uterine prolapse:

The uterus is held in place within the pelvis by a group of muscles and ligaments. As these structures weaken, they become unable to hold the uterus in position, and it begins to sag. There are several factors that may contribute to the weakening of the pelvic muscles, including:

• Loss of muscle tone as the result of aging
• Injury during childbirth, especially if the woman has had many babies or large babies (more than 9 pounds)
• Other factors (Obesity, chronic coughing or straining and chronic constipation all place added tension on the pelvic muscles, and may contribute to the development of uterine prolapse.)

How is uterine prolapse diagnosed?

The doctor will perform a pelvic examination to determine if the uterus has lowered from its normal position. During a pelvic exam, the doctor inserts a speculum (an instrument that lets the clinician see inside the vagina) and examines the vagina and uterus. The doctor will feel for any bulges caused by the uterus protruding into the vaginal canal.

How is uterine prolapse treated?

There are surgical and non-surgical options for treating uterine prolapse. The treatment chosen will depend on the severity of the condition, as well as the woman's general health, age and desire to have children. Treatment generally is effective for most women. Treatment options include the following.

Non-surgical options

A) Exercise -- Special exercises, called Kegel exercises, can help strengthen the pelvic floor muscles. This may be the only treatment needed in mild cases of uterine prolapse. To do Kegel exercises, tighten your pelvic muscles as if you are trying to hold back urine. Hold the muscles tight for a few seconds and then release. Repeat 10 times. You may do these exercises anywhere and at any time (up to four times a day).

B) Vaginal pessary -- A pessary is a rubber or plastic doughnut-shaped device that fits around or under the lower part of the uterus (cervix), helping to prop up the uterus and hold it in place. A health care provider will fit and insert the pessary, which must be cleaned frequently and removed before sex.

C) Estrogen replacement therapy (ERT)  Taking estrogen may help to limit further weakness of the muscles and other connective tissues that support the uterus. However, there are some drawbacks to taking estrogen, such as an increased risk of blood clots, gallbladder disease and breast cancer. The decision to use ERT must be made with your doctor after carefully weighing all of the risks and benefits.

Surgical options

A) Hysterectomy -- Uterine prolapse may be treated by removing the uterus in a surgical procedure called hysterectomy. This may be done through an incision made in the vagina (vaginal hysterectomy) or through the abdomen (abdominal hysterectomy). Hysterectomy is major surgery, and removing the uterus means pregnancy is no longer possible.

B) Uterine suspension -- This procedure involves putting the uterus back into its normal position. This may be done by reattaching the pelvic ligaments to the lower part of the uterus to hold it in place. Another technique uses a special material that acts like a sling to support the uterus in its proper position.  Recent advances include performing this with minimally invasive techniques and laparoscopically (through small band aid sized incisions) that decrease post operative pain and speed recovery.

What are possible complications of uterine prolapse?

Ulceration and infection of the 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.