Prolapsed Uterus Overview
Your uterus (or womb) is normally held in place inside your pelvis with various muscles, tissue, and ligaments. Because of pregnancy, childbirth or difficult labor and delivery, in some women these muscles weaken. Also, as a woman ages and with a natural loss of the hormone estrogen, her uterus can drop into the vaginal canal, causing the condition known as a prolapsed uterus.
- Muscle weakness or relaxation may allow your uterus to sag or come completely out of your body in various stages:
- First degree: The cervix drops into the vagina.
- Second degree: The cervix drops to the level just inside the opening of the vagina.
- Third degree: The cervix is outside the vagina.
- Fourth degree: The entire uterus is outside the vagina. This condition is also called procidentia. This is caused by weakness in all of the supporting muscles.
- Other conditions are usually associated with prolapsed uterus. They weaken the muscles that hold the uterus in place:
- Cystocele: A herniation (or bulging) of the upper front vaginal wall where a part of the bladder bulges into the vagina. This may lead to urinary frequency, urgency, retention, and incontinence (loss of urine).
- Enterocele: The herniation of the upper rear vaginal wall where a small bowel portion bulges into the vagina. Standing leads to a pulling sensation and backache that is relieved when you lie down.
- Rectocele: The herniation of the lower rear vaginal wall where the rectum bulges into the vagina. This makes bowel movements difficult, to the point that you may need to push on the inside of your vagina to empty your bowel.
Prolapsed Uterus Causes
The following conditions can cause a prolapsed uterus:
- Pregnancy/childbirths with normal or complicated delivery through the vagina
- Weakness in the pelvic muscles with advancing age
- Weakening and loss of tissue tone after menopause and loss of natural estrogen
- Conditions leading to increased pressure in the abdomen such as chronic cough (with bronchitis and asthma), straining (with constipation), pelvic tumors (rare), or an accumulation of fluid in the abdomen
Being overweight or obese with its additional strain on pelvic muscles
- Major surgery in the pelvic area leading to loss of external support
Other risk factors include:
- Excess weight lifting
- Being Caucasian
- Family history
Prolapsed Uterus Symptoms
Symptoms of a prolapsed uterus include:
- A feeling of fullness or pressure in your pelvis (you may describe it as a feeling of sitting on a small ball)
- Low back pain
- Feeling that something is coming out of your vagina
- Painful sexual intercourse
- Difficulty with urination or moving your bowels
- Discomfort walking
When to Seek Medical Care
Notify your health care provider if you experience any of the following symptoms:
- You feel the cervix near the opening of the vaginal canal or you feel pressure in your vaginal canal and the feeling of something coming out of your vagina.
- You suffer persistent discomfort from urinary dribbling or the urge to have a bowel movement (rectal urgency).
- You have continuing low back pain with difficulty in walking, urinating, and moving your bowels.
Seek medical care immediately if you experience any of the following:
- Obstruction or difficulty in urination and/or bowel movement
- Complete uterine prolapse (your uterus comes out of your vagina)
Exams and Tests
- The doctor may need to examine you in standing position and while you are lying down and ask you to cough or strain to increase the pressure in your abdomen.
- Specific conditions, such as ureteral obstruction due to complete prolapse, may need an intravenous pyelogram (IVP) or renal sonography. Dye is injected into your vein, and a series of X-rays are taken to view its progress through your bladder.
- Ultrasound may be used to rule out other pelvic problems. In this test, a wand is passed over your abdomen or inserted into your vagina to create images with sound waves.
Prolapsed Uterus Treatment
Treatment depends on how weak the supporting structures around your uterus have become.
Self-Care at Home
You can strengthen your pelvic muscles by performing Kegel exercises. You do these by tightening your pelvic muscles, as if trying to stop the flow of urine. This exercise strengthens the pelvic diaphragm and provides some support. Have your health care provider instruct you on the proper ways to isolate and exercise the muscles.
Estrogen (a hormone) cream or suppository ovules or rings inserted into the vagina help in restoring the strength and vitality of tissues in the vagina. But estrogen is only for use in select postmenopausal women.
Depending on your age and whether you wish to become pregnant, surgery can repair the uterus or remove it. When indicated, and in severe cases, your uterus can be removed with a hysterectomy. During the surgery, the surgeon can also correct the sagging of the vaginal walls, urethra, bladder, or rectum. The surgery may be performed by an open abdominal procedure, through the vagina, or through small incisions in the abdomen or vagina with specialized instruments.
If you do not want surgery or are a poor candidate for surgery, you may decide to wear a supportive device, called a pessary, in your vaginal canal to support the falling uterus. You can use this temporarily or permanently. They come in various shapes and sizes and must be fitted to you. If your prolapse is severe, a pessary may not work. Also, pessaries can be irritating inside your vagina and may cause a foul-smelling discharge.
Follow-up depends on how your condition was treated.
- If you had surgery, you need to follow up according to your surgeon's advice.
- If you have a pessary inserted in your vagina, it needs to be cleaned and checked by your health care provider for the correct position and fit at regular intervals unless you are instructed on how to remove it and clean it yourself at home.
- If you have been told to do Kegel exercises, you should have a regular follow-up visit so that your health care provider can check the progress of your muscle strength.
Pessaries can be effective temporarily or permanently if they are checked and cleaned as often as necessary. Surgery can support a prolapsed uterus or remove it.