Overview, Causes, & Risk Factors
Uterine prolapse is the "dropping" of the uterus from its normal position at the top of the vagina. It drops to a lower part of the vagina and may even drop outside the vagina. This is caused by a relaxation of the ligaments that support the uterus within the abdominal walls.
What is going on in the body?
Uterine prolapse occurs more
commonly in white women, and in women who:
have given birth vaginally to many children
have given birth to large babies
have had forceps deliveries
These things may have caused injury to the pelvic ligaments and muscles.
Symptoms may not occur until many years after women have given birth. This
suggests that aging and shrinkage of these muscles also adds to the problem.
Uterine prolapse sometimes occurs in women who have never given birth. In
these cases, the condition is due to a family tendency to have weak muscles
that hold the uterus in place.
Some women have what is known as a "tipped uterus." This type of uterus is
especially at risk to prolapse. This is due to its alignment along the same
line as the vagina. It may be subject to a "piston-like effect." This happens when a woman uses her abdominal muscles, which push the uterus down into the vagina.
There are many different degrees of prolapse. Incomplete prolapse occurs
when the uterus drops only partway into the vagina. Complete prolapse occurs
when the uterus and cervix protrude out of the vagina and the vagina becomes
inverted. Along with uterine prolapse there may be relaxation of the front and back portions of the vagina. This can cause a part of the bladder or rectum to protrude into the vagina.
What are the causes and risks of the condition?
The risk factors for developing uterine prolapse include:
multiple vaginal births
giving birth to large babies (more than 9 pounds)
difficult instrumented deliveries (forceps, vacuum)
presence of a pelvic tumor
Symptoms & Signs
What are the signs and symptoms of the condition?
Mild prolapse may not cause any symptoms. With more severe prolapse, a woman may have:
a falling out sensation
a feeling like she's sitting on a ball
sensation of pelvic heaviness
lower abdominal discomfort
increased vaginal discharge
increased urinary tract infections
increased desire to urinate or more frequent urination
stress incontinence, or
leakage of urine that is worsened by coughing, sneezing, or lifting objects
a feeling of not having completely emptied the bladder
painful bowel movements
Diagnosis & Tests
How is the condition diagnosed?
A healthcare provider can
tell during a pelvic exam if the
cervix is in a lowered position in the vagina. The pelvic exam may also show a part of the bladder or rectum protruding into the vagina.
Prevention & Expectations
What can be done to prevent the condition?
While uterine prolapse is not always avoidable, some cases can be avoided by:
doing Kegel exercises during pregnancy and after giving birth to strengthen pelvic muscles
an episiotomy, or cut made in
the perineum and vaginal wall during labor
taking hormone replacement
therapy for a long time during and after menopause to maintain the tone of the pelvic muscles
What are the long-term effects of the condition?
The long-term effects of uterine prolapse depend on how severe it is and how long a woman has had the condition. Some long-term effects include:
abnormal uterine bleeding
increased vaginal discharge
chronic vaginal infections
chronic bladder infections, known as recurrent cystitis
partial urethral obstruction
small bowel obstruction
incarceration of the uterus within the pelvis. This occurs with rapid
growth of a pregnant uterus that becomes trapped in the pelvis, cutting off its blood supply.
What are the risks to others?
Uterine prolapse is not contagious, and poses no risk to others.
Treatment & Monitoring
What are the treatments for the condition?
Treatment for uterine prolapse
depends on many things, including:
the severity of the prolapse
the severity of the symptoms
the presence of other signs and symptoms
a woman's wishes to preserve her fertility
the woman's age
Treatment options include:
pessary, a plastic doughnut-shaped device placed into the vagina to push up the uterus
round ligament suspension procedure, an operation to provide muscle support to the uterus
estrogen therapy given
directly into the vagina with creams
hysterectomy, or surgery to
remove the uterus
What are the side effects of the treatments?
The side effects depend on the treatment. The use of hormone replacement therapy may
cause nausea, weight gain, abdominal bloating, increased vaginal discharge, and breast tenderness. After a hysterectomy a woman will need 6 to 8 weeks to
recuperate. There are possible side effects with any surgery. These include
bleeding, infection, and allergic
reactions to anesthesia.
What happens after treatment for the condition?
treatment of a prolapsed uterus, a woman should:
avoid lifting heavy objects
prevent constipation by
plenty of fluids, using stool softeners for a short time, and increasing her
perform Kegel exercises daily
lose weight through diet and exercise, if she is overweight
continue with hormone replacement
therapy, if she was using it before surgery
avoid wearing tight girdles or other garments that put pressure on the
How is the condition monitored?
Any new or worsening symptoms should be reported to the healthcare provider.