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Uterine prolapse
Definition
Uterine prolapse is falling or sliding of the womb (uterus) from its normal position into the vaginal area.
Alternative Names
Pelvic relaxation - uterine prolapse; Pelvic floor hernia; Prolapsed uterus
Causes
Muscles, ligaments, and other structures hold the uterus in the pelvis. If these muscles and structures are weak, the uterus drops into the vaginal canal . This is called prolapse.
This condition is more common in women who have had one or more vaginal births.
Other things that can cause or lead to uterine prolapse include:
- Normal aging
- Lack of estrogen after menopause
- Anything that puts pressure on the pelvic muscles, including chronic cough and obesity
- Pelvic tumor (rare)
Long-term constipation and the pushing associated with it can make this condition worse.
Symptoms
- Feeling like you are sitting on a small ball
- Difficult or painful sexual intercourse
- Frequent urination or a sudden urge to empty the bladder
- Low backache
- Uterus and cervix that stick out through the vaginal opening
- Repeated bladder infections
- Feeling of heaviness or pulling in the pelvis
- Vaginal bleeding
- Increased vaginal discharge
Many of the symptoms are worse when standing or sitting for long periods of time.
Exams and Tests
A pelvic examination is done while you are bearing down, as if you were trying to push out a baby. This shows your doctor how far your uterus has dropped.
- Mild terine prolapse is mild when the cervix drops into the lower part of the vagina.
- Uterine prolapse is moderate when the cervix drops out of the vaginal opening.
The pelvic exam may also show that the bladder and front wall of the vagina (cystocele), or rectum and back wall of the vagina (rectocele) are entering the vagina. The urethra and bladder may also be lower in the pelvis than usual.
Treatment
Treatment is not necessary unless the symptoms bother you. Many women seek treatment by the time the uterus drops to the opening of the vagina.
LIFESTYLE CHANGES
Weight loss is recommended in obese women with uterine prolapse.
Heavy lifting or straining should be avoided, because they can worsen symptoms.
Coughing can also make symptoms worse. If you a chronic cough, ask your doctor how to prevent or treat it. If you smoke, try to quit. Smoking can cause a chronic cough.
VAGINAL PESSARY
Your doctor may recommend placing a rubber or plastic donut-shaped device, called a pessary, into the vagina. This device hold the uterus in place. It may be temporary or permanent. Vaginal pessaries are fitted for each individual woman. Some are similar to a diaphragm used for birth control.
Pessaries must be cleaned from time to time, sometimes by the doctor or nurse. Many women can be taught how to insert, clean, and remove the pessary herself.
Side effects of pessaries include:
- Foul smelling discharge from the vagina
- Irritation of the lining of the vagina
- Ulcers in the vagina
- Problems with normal sexual intercourse and penetration
SURGERY
Surgery should not be done until the prolapse symptoms are worse than the risks of having surgery. The specific type of surgery depends on:
- Degree of prolapse
- Desire for future pregnancies
- Other medical conditions
- The women's desire to retain vaginal function
- The woman's age and general health
There are some surgical procedures that can be done without removing the uterus, such as a sacrospinous fixation . This procedure involves using nearby ligaments to support the uterus. Other procedures are available.
Often, a vaginal hysterectomy is used to correct uterine prolapse. Any sagging of the vaginal walls, urethra, bladder, or rectum can be surgically corrected at the same time.
Outlook (Prognosis)
Most women with mild uterine prolapse do not have bothersome symptoms and don't need treatment.
Vaginal pessaries can be effective for many women with uterine prolapse.
Surgery usually provides excellent results, however, some women may require treatment again in the future.
Possible Complications
Ulceration and infection of the cervix and 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.
When to Contact a Medical Professional
Call for an appointment with your health care provider if you have symptoms of uterine prolapse.
Prevention
Tightening the pelvic floor muscles using Kegel exercises helps to strengthen the muscles and reduces the risk of uterine prolapse.
Estrogen therapy, either vaginal or oral, in postmenopausal women may help maintain muscle tone in the vaginal area.
Weight loss and avoiding heavy lifting can decrease the risk for uterine prolapse.
References
Lentz GM. Anatomic defects of the abdominal wall and pelvic floor: abdominal and inguinal hernias, cystocele, urethrocele, enterocele, rectocele, uterine and vaginal prolapse, and rectal incontinence: diagnosis and management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, PA: Mosby Elsevier;2007:chap 20.
Atnip SD. Pessary use and management for pelvic organ prolapse. Obstet Gynecol Clin North Am. 2009 Sep;36(3):541-63.
Young SB. Vaginal surgery for pelvic organ prolapse. Obstet Gynecol Clin North Am. 2009 Sep;36(3):565-84.
McDermott CD, Hale DS. Abdominal, laparoscopic, and robotic surgery for pelvic organ prolapse. Obstet Gynecol Clin North Am. 2009 Sep;36(3):585-614.
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
