The Causes, Symptoms and Treatment of Uterine Prolapse

Uterine prolapse is a condition that occurs when the pelvic floor musclesare no longer strong enough to support the uterus. As a result, the uterus descends toward or through the vagina.

In the US, the Women’s Health Initiative found some degree of prolapse in 44% of participating women. Among these women, 14% of prolapse cases were uterine prolapse.

What is uterine prolapse?

Uterine prolapse is a condition in which a woman’s uterus (womb) slips into the vagina. In some cases, the uterus can protrude from the vaginal opening.

This condition occurs when the muscles and ligaments within the pelvis become weak or lax and are unable to adequately support the uterus.

Uterine prolapse can be categorized as incomplete or complete:

• Incomplete uterine prolapse: when an incomplete uterine prolapse occurs, the uterus is partially displaced into the vagina but does not protrude
• Complete uterine prolapse: when a complete uterine prolapse occurs, there is a portion of the uterus protruding out of the vaginal opening.

Uterine prolapse is graded by its severity, determined by how far the uterus has descended:

• 1st grade: descended to the upper vagina
• 2nd grade: descended to the introitus
• 3rd grade: cervix has descended outside the introitus
• 4th grade: cervix and uterus have both descended outside the introitus.

In some cases, uterine prolapse can cause complications, including ulceration of exposed tissue and prolapse of other pelvic organs such as the bladder (cystocele) or rectum (rectocele).

Symptoms of uterine prolapse

Symptoms of uterine prolapse can vary depending on its severity.

Typical symptoms of uterine prolapse include:

• Pelvic heaviness or pulling
• Vaginal bleeding or an increase in vaginal discharge
• Difficulties with sexual intercourse
• Urinary leakage, retention or bladder infections
• Bowel movement difficulties, such as constipation
• Lower back pain
• Uterine protrusion from the vaginal opening
• Sensations of sitting on a ball or that something is falling out of the vagina
• Lax vaginal tissue.

Mild cases of uterine prolapse may be asymptomatic. Symptoms that do present often become worse in the latter part of the day.

Causes of uterine prolapse

Uterine prolapse is the result of lax pelvic floor muscles that can be caused by a multitude of conditions:

• Pregnancy and childbirth: not only can pregnancy be a contributing factor, but trauma during childbirth, a large baby or a vaginal delivery can increase a woman’s risk of developing uterine prolapse
• Age: increasing age places a woman at higher risk for developing uterine prolapse; menopausal woman are at a higher risk due to lower levels of circulating estrogen
• Frequent heavy lifting
• Straining during bowel movements
• Chronic coughing (chronic obstructive pulmonary disease, for example)
• A history of pelvic surgery
• Genetic predisposition to having weakened connective tissue.

Diagnosis of uterine prolapse

During an evaluation for uterine prolapse, your health care provider may evaluate your symptoms and perform a physical exam. During the pelvic portion of your physical exam, your provider will evaluate for organ placement and vaginal tone.

Additional tests such as an ultrasound or magnetic resonance imaging (MRI) may be used to evaluate the severity of the prolapse.

Treatment for uterine prolapse

Mild uterine prolapse can be treated with Kegel exercises, weight management and avoidance of heavy lifting. Monitoring for worsening of prolapse is necessary. At times, estrogen replacement therapy may be recommended.

How to do a proper Kegel is vital to the success of the treatment. These exercises can be done anywhere and at any time and are beneficial for strengthening the muscles of the pelvic floor.

Your health care provider or physical therapist can instruct you on how to perform a proper Kegel while in the office, at which time proper technique can be evaluated.

At times, a technique called biofeedback may be necessary. During biofeedback treatments, a device will monitor proper muscle contraction, the strength of the pelvic floor and timing of Kegels; this reinforces proper technique of the exercises.

In order to perform a proper Kegel, you will need to:

• Tighten the pelvic floor muscles, as if you are attempting to stop urinating and hold for 5 seconds
• Take a 5-second break and repeat for 3 sets, 10 times per day.

The ultimate goal is to hold the contraction for 10 seconds each time the exercise is performed.

More severe cases of uterine prolapse may require treatment, including:

Vaginal pessary: a vaginal pessary is a vaginal device which supports the uterus and keeps it in position. You will be instructed on care, removal and insertion of the pessary. At times, in cases of severe prolapse, a pessary can cause irritation, ulceration and sexual problems. Discuss with your provider if this treatment is right for you.

Surgery: surgical repair of a prolapsed uterus can be performed through the vagina or abdomen and involves skin grafting, donor tissue or other material to provide uterine suspension. At times, a hysterectomy (removal of the uterus) may be recommended.

If future pregnancies are intended, surgery may not be recommended due to the risk of undoing the effects of surgical repair.

Prevention of uterine prolapse

As with any medical condition, uterine prolapse may or may not be preventable. To reduce the risk of uterine prolapse developing, consider the following:

• Perform Kegel exercises regularly
• Prevent and treat constipation
• Avoid heavy lifting
• Use correct body mechanics whenever lifting is necessary
• Manage chronic coughing
• Maintain a healthy weight through diet and exercise
• Consider estrogen replacement therapy during menopause.

Speak with our office if you have any questions or for the evaluation and treatment of symptoms of uterine prolapse. We can make recommendations on a treatment choice that is best for you.