Uterine Prolapse

What is a sagging uterus?

The uterus (womb) is a muscular structure held in place by pelvic muscles and ligaments. If these muscles or ligaments are stretched or weakened, they cannot support the uterus, causing a prolapse.

Uterine prolapse occurs when the uterus sags or slides out of its normal position and into the vagina (birth canal).

Uterine prolapse may be incomplete or complete. An incomplete prolapse occurs when the uterus only partially protrudes into the vagina. A complete prolapse occurs when the uterus falls downward so that some tissue protrudes out of the vagina.

What are the symptoms of uterine prolapse?

Women with minor uterine prolapse may have no symptoms. Moderate to severe prolapse can cause symptoms such as:

  • the feeling that you are sitting on a ball
  • vaginal bleeding
  • increased discharge
  • sexual intercourse problems
  • protruding from the uterus or cervix out of the vagina
  • a pulling or heavy feeling in the pelvis
  • constipation or difficulty passing stools
  • recurrent bladder infections or difficulty emptying your bladder

If you develop these symptoms, you should see your doctor and seek treatment right away. Without proper attention, the discomfort can affect your bowels, bladder and sexual function.

Are there any risk factors?

The risk of having a molten uterus increases as a woman ages and her estrogen levels decrease. Estrogen is the hormone that helps keep pelvic muscles strong. Damage to pelvic muscles and tissues during pregnancy and childbirth can also cause prolapse. Women who have had multiple vaginal deliveries or have been postmenopausal are at highest risk.

Any activity that puts pressure on the pelvic muscles can increase your risk of uterine prolapse. Other factors that can increase your risk for the condition include:

  • obesity
  • chronic cough
  • chronic constipation

How is this condition diagnosed?

Your doctor can diagnose uterine prolapse by evaluating your symptoms and performing a pelvic exam. During this exam, your doctor will insert a device called a speculum that allows them to see inside the vagina and examine the vaginal canal and uterus. You may be lying down, or your doctor may ask you to stand during this exam.

Your doctor may ask you to go down as if you were having a bowel movement to determine the degree of prolapse.

How is it treated?

Treatment is not always necessary for this condition. If the prolapse is severe, talk to your doctor about which treatment option is right for you.

Non-surgical treatments include:

  • losing weight to take stress off pelvic structures
  • avoiding heavy lifting
  • doing Kegel exercises, which are pelvic floor exercises that help strengthen the vaginal muscles
  • wearing a pessary, which is a device inserted into a vagina that goes under the cervix and pushes up and stabilizes the uterus and cervix

The use of vaginal estrogen has been well studied and shows improvement in vaginal tissue regeneration and strength. While using vaginal estrogen to help increase other treatment options may be helpful, it will not in itself reverse the presence of a prolapse.

Surgical treatments are uterine suspension or hysterectomy. During uterine suspension, your surgeon places the uterus back in its original position by reattaching the pelvic ligaments or using surgical materials. During a hysterectomy, your surgeon removes the uterus from the body through the abdomen or vagina.

Surgery is usually effective, but is not recommended for women planning to have children. Pregnancy and childbirth can put a great strain on the pelvic muscles, which can undo the surgical repair of the uterus.

Is there a way to prevent uterine prolapse?

Uterine prolapse may not be preventable in all cases. However, you can do a few things to reduce your risk, including:

  • doing regular physical exercise
  • maintaining a healthy weight
  • doing kegel exercises
  • Seeking treatment for things that increase the amount of pressure on your pelvis, including chronic constipation or coughing

Resources:

Burrows LJ et al. (2004). Pelvic symptoms in women with pelvic organ prolapse [Özet].

Maher C, et al. (2013). Surgical treatment of pelvic organ prolapse in women [Özet]. DOI:

Mayo Clinic Staff. (2018). Uterine prolapse.

Rahn DD, et al. Effects of preoperative local estrogen with prolapse in postmenopausal women: a randomized trial.

Vaginal and uterine prolapse. (2015).

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