UTERINE PROLAPSE
Uterine prolapse is a common condition
that can happen as a person ages. Over
time, and with multiple vaginal childbirths,
the muscles and ligaments around the
uterus weaken. When this support structure
starts to fail, the uterus can sag out of
position. Treatment for uterine prolapse
involves surgical and nonsurgical options
based on the severity of the prolapse.
Introduction
Uterine prolapse is a condition where the muscles and
tissues around the uterus become weak. This causes the
uterus to sag or drop down into the vagina. It can
happen to anyone assigned female at birth (AFAB), but is
most common after menopause and in people who’ve
had more than one vaginal delivery.
The muscles, ligaments and tissues in the pelvis are
called the pelvic floor muscles. These muscles support
the uterus, rectum, vagina, bladder and other pelvic
organs. A prolapse occurs when the pelvic floor muscles
are damaged or weakened to the point where they can
no longer provide support. This causes the pelvic organs
to drop into or out of the vagina.
Definition
Uterine prolapse can be mild or severe
depending on how weak the supporting
muscles of the uterus have become. In an
incomplete prolapse, the uterus may have
slipped enough to be partway in the
vagina. This creates a lump or bulge. In a
more severe case, the uterus can slip far
enough that it comes out of the vagina.
This is called a complete prolapse
. The stages of uterine prolapse are:
Stage I: uterus drops into the upper part
of vagina.
Stage II: uterus falls into the lower part
of vagina.
Stage III: uterus is protruding from
vagina.
Stage IV: entire uterus slips outside of
vagina.
What are the stages of uterine prolapse?
Uterine prolapse is most likely to happen
in people who:
Have had one or more vaginal deliveries.
Have reached menopause.
Have a family history of uterine prolapse.
Have had prior pelvic surgeries.
Who gets uterine prolapse?
Uterine prolapse can disrupt normal
activities and be uncomfortable. Very mild
cases may not require treatment or cause
any discomfort. However, severe cases
may make it difficult to pee or have a
normal bowel movement. Uterine prolapse
is typically a quality of life issue, and
healthcare providers treat it when
symptoms of the condition begin to
interfere with your daily life.
How serious is a prolapsed uterus?
A feeling of heaviness, fullness or pressure in your pelvis.
Pain in your pelvis, abdomen or lower back.
Pain during sex (intercourse).
Uterine tissue that falls through the opening of your vagina.
Trouble inserting tampons or other applicators into your
vagina.
Constipation.
Urination problems, including leaking pee (incontinence), the
need to pee frequently (urinary frequency) or the sudden
urge to pee (urinary urgency).
Symptoms can get worse when you stand or walk for long
periods of time or when you cough and sneeze. In these
positions, gravity puts extra pressure on your pelvic muscles.
SIGNS AND SYMPTOMS
Loss of muscle tone as the result of
menopause.
Pregnancy.
Vaginal childbirth, especially if you’ve had
many babies or large babies (more than 9
pounds).
Obesity.
Chronic coughing or straining.
Chronic constipation.
Repeated heavy lifting.
CAUSES
Other organs in your pelvic region can fall
out of position when the muscles around it
become too weak. Some of the other types
of pelvic organ prolapse are:
Cystocele: When your bladder drops into or
out of your vagina.
Rectocele: When your rectum bulges into or
out of your vagina.
Enterocele: When part of your small
intestine bulges into your vagina.
CONDITIONS ASSOCIATED WITH
UTERINE PROLAPSE
perform a pelvic examination to determine if the
uterus has lowered from its normal position.
During a pelvic exam, the healthcare provider
inserts a speculum (an instrument that lets them
see inside the vagina) and examines the vagina
and uterus.
She will feel for any bulges caused by the uterus
dropping down into the vaginal canal. They may
also ask to cough, strain or act like you’re holding
in the pee. This can help them see how weak the
muscles are.
DIAGNOSIS
There are surgical and nonsurgical options
for treating uterine [Link]
healthcare provider will pick the treatment
path based on the severity of the
prolapse, the general health, age and
whether or not the patient want children
in the future. Treatment is generally
effective for most people. Treatment
options can include:
Management
Exercise: Special exercises, called Kegel exercises, can help
strengthen the pelvic floor muscles. This may be the only
treatment needed in mild cases of uterine prolapse. To do
Kegel exercises, tighten the pelvic muscles as if trying to
hold back urine. Hold the muscles tight for a few seconds and
then release. Repeat 10 times. The women may do these
exercises anywhere and at any time (up to four times a day).
Vaginal pessary: A pessary is a rubber or plastic doughnut-
shaped device that fits around or under the lower part of the
uterus (cervix). This device helps prop up your uterus and
hold it in place. A healthcare provider will fit and insert the
pessary, which must be cleaned frequently and removed
before sex.
Nonsurgical options
Diet and lifestyle: Changes to diet and
lifestyle may be helpful in relieving
symptoms like constipation. Increasing
water and fiber intake may lessen how
often you strain to poop. Maintaining a
healthy weight for body type puts less
pressure on pelvic muscles when the
women stand or walk.
Hysterectomy and prolapse repair: Uterine prolapse
may be treated by removing the uterus in a surgical
procedure called a hysterectomy. This may be done through
a cut (incision) made in the vagina (vaginal hysterectomy)
or through the abdomen (abdominal hysterectomy).
Hysterectomy is major surgery, and removing your uterus
means pregnancy is no longer possible.
Prolapse repair without hysterectomy: This procedure
involves putting the uterus back into its normal position.
Uterine suspension may be done by reattaching the pelvic
ligaments to the lower part of the uterus to hold it in place.
The surgery can be done through the vagina or through the
abdomen depending on the technique.
Surgical options
It depends on the severity of the prolapse.
In mild cases where quality of life isn’t
affected, the healthcare provider may not
recommend treatment. Uterine prolapse
can affect other organs in the pelvic area
of the body (like your bladder and
rectum). Healthcare providers typically
recommend treatment when uterine
prolapse becomes bothersome.
What happens if a prolapsed uterus is left
untreated?
Some factors like having multiple vaginal births or
experiencing menopause can’t be avoided.
There are ways to reduce risk of developing a prolapse. A
few lifestyle tips that can reduce risk of prolapse include:
Maintain a healthy weight and exercise regularly.
Do Kegel exercises to strengthen pelvic floor muscles.
Stop smoking. This reduces the risk of developing a
chronic cough, which can put extra strain on pelvic
muscles.
Using proper lifting techniques when carrying heavy
objects.
Avoid becoming constipated or straining to poop
How can I reduce my risk of uterine prolapse?
